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Is late-onset Alzheimer's disease really a disease of midlife?
Karen Ritchie1,2, Craig W Ritchie3,4, Kristine Yaffe5
1Institut National de la Santé et de la Recherche Médicale, U1061 Neuropsychiatry, Montpellier, France.
Introduction:
Increasing evidence suggests that Alzheimer's disease (AD) may begin decades before evidence of dementia, indicating that it may be a disorder of midlife rather than old age.
Methods:
In the absence of long-term prospective studies from early adulthood specifically designed to address this question, a group of international experts examined evidence presently available from previous clinical and population studies to provide an evidence-based opinion as to whether such a change in conceptualization may be justified.
Results:
Although still lacking confirmation from dedicated prospective biomarker studies, there is already considerable evidence to suggest both risk factor exposure and brain changes may be already present in midlife.
Discussion:
Current evidence suggests (1) that a change in clinical approach notably involving promotion of cardiovascular health in persons with a family history of AD may considerably reduce disease risk and (2) that the development of biomarkers at this early stage will lead to the possibility of clinical trials at a much earlier stage.