Blood Tests May Help Physicians in Low-Resource Environments Diagnose Alzheimer Disease
Columbia University neurologists are investigating a set of blood tests that, used in combination with memory tests, may help physicians correctly diagnose Alzheimer disease in low-resource environments, where 58% of people worldwide living with dementia reside.
Low-resource communities often lack specialists who can diagnose Alzheimer disease or do not have access to brain imaging machines that can confirm a diagnosis of Alzheimer disease. Biomarkers in spinal fluid can confirm a diagnosis, but patients may not wish to have a lumbar puncture to remove cerebrospinal fluid.
In recent years, blood-based biomarkers have been found that perform almost as well as biomarkers in spinal fluid in identifying people with Alzheimer disease. Few studies have been conducted in low-resource communities to determine if the blood tests could help physicians accurately identify individuals with Alzheimer disease.
In a new study, Columbia researchers in collaboration with local physicians recruited 746 older adults (average age of 71 years) from the Dominican Republic and the Dominican community of northern Manhattan.
Each participant underwent detailed neurological and cognitive testing. A panel of Columbia neurologists, expert in Alzheimer diagnosis, analyzed the results to judge whether participants had Alzheimer disease, other forms of dementia, or normal cognitive aging. Blood was drawn from each participant to measure blood-based biomarkers for Alzheimer disease.
Among the study participants, just over 20% were given a clinical diagnosis of Alzheimer disease. The blood tests showed that these individuals also had higher levels of Alzheimer biomarkers (including phosphorylated tau, neurofilament light chain, and glial fibrillary acidic protein).
Remarkably, these blood-based tests also may identify the earliest biological signs of Alzheimer disease before the onset of symptoms. In this study, about 20% of participants who were not diagnosed with the disease based on their performance on memory and cognitive tests had elevations of phosphorylated tau, neurofilament light chain, and glial fibrillary acidic protein in their blood.
This finding suggests that the blood tests may be a sensitive indicator of preclinical Alzheimer disease. As more preventive strategies become available, early recognition in the preclinical stage would be beneficial.
“Alzheimer’s disease is one form of dementia and as more treatments emerge, developing an accurate blood test will be essential in finding people who will benefit from treatment, particularly those who lack access to more advanced diagnostic tools,” says Richard Mayeux, MD, chair of the Department of Neurology at Columbia University Vagelos College of Physicians and Surgeons and one of the study’s senior authors.
More research is needed to determine how the blood-based biomarker tests can be used in the clinic; the tests are not currently available outside of research studies.
Richard Mayeux, MD, is the Gertrude H. Sergievsky Professor of Neurology, Psychiatry and Epidemiology at Columbia University and Neurologist-in-Chief at NewYork-Presbyterian/Columbia University Irving Medical Center, director of the Gertrude H. Sergievsky Center at Columbia, and co-director of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Irving Medical Center.
The study, titled, “Evaluation of Plasma Biomarkers for A/T/N Classification of Alzheimer Disease Among Adults of Caribbean Hispanic Ethnicity,” was published April 20 in JAMA Network Open.
All authors (from Columbia University unless noted): Lawrence S. Honig, Min Suk Kang, Annie J. Lee, Dolly Reyes-Dumeyer, Angel Piriz, Belisa Soriano (Universidad Pedro Henríquez Urena, Santo Domingo, Dominican Republic), Yahaira Franco (Clínica Corominas, Santiago, Dominican Republic), Zoraida Dominguez Coronado (Clínica Gregorio Hernandez, Puerto Plata, Dominican Republic), Patricia Recio (Center for Diagnosis, Advanced Medicine and Telemedicine, Santo Domingo, Dominican Republic), Diones Rivera Mejía (Universidad Pedro Henríquez Urena), Martin Medrano (Pontífica Universidad Católica Madre y Maestra, Dominican Republic), Rafael Lantigua, Andrew F. Teich, Jeffrey L. Dage (Indiana University), and Richard Mayeux.
This work was supported by the National Institute on Aging (grants R01AG067501 and R01AG072474).
Full disclosures are listed in the paper.