Perspectives and challenges in patient stratification in Alzheimer's disease
- PMID: 35964143
- PMCID: PMC9375274
- DOI: 10.1186/s13195-022-01055-y
Perspectives and challenges in patient stratification in Alzheimer's disease
Abstract
Background: Patient stratification is the division of a patient population into distinct subgroups based on the presence or absence of particular disease characteristics. As patient stratification can be used to account for the underlying pathology of a disease, it can help physicians to tailor therapeutic interventions to individuals and optimize their care management and treatment regime. Alzheimer's disease, the most common form of dementia, is a heterogeneous disease and its management benefits from patient stratification in clinical trials, and the development of personalized care and treatment strategies for people living with the disease.
Main body: In this review, we discuss the importance of the stratification of people living with Alzheimer's disease, the challenges associated with early diagnosis and patient stratification, and the evolution of patient stratification once disease-modifying therapies become widely available.
Conclusion: Patient stratification plays an important role in drug development in clinical trials and may play an even larger role in clinical practice. A timely diagnosis and stratification of people living with Alzheimer's disease is paramount in determining people who are at risk of progressing from mild cognitive impairment to Alzheimer's dementia. There are key issues associated with stratifying patients which include the heterogeneity and complex neurobiology behind Alzheimer's disease, our inadequately prepared healthcare systems, and the cultural perceptions of Alzheimer's disease. Stratifying people living with Alzheimer's disease may be the key in establishing precision and personalized medicine in the field, optimizing disease prevention and pharmaceutical treatment to slow or stop cognitive decline, while minimizing adverse effects.
Keywords: Alzheimer’s disease; Biomarkers; Cultural perceptions of dementia; Dementia; Disease-modifying therapy; Early diagnosis; Mild cognitive impairment; Patient stratification; Precision medicine; Stigma.
© 2022. The Author(s).
Conflict of interest statement
C.A. has received lecture fees paid by a commercial entity (honoraria) in the last 3 years from Zambon, F. Hoffmann-La Roche Ltd, Schwabe Farma Ibérica S.A.U., and Nutricia.
F.A. serves as Section Editor of
M.B. has received compensation for consulting services and/or lecture fees from Biogen and F. Hoffmann-La Roche Ltd.
B.F. has received lecture fees paid by a commercial entity (honoraria) in the last 3 years from Pfizer, Biophytis, BMS, Novartis, Bayer, F. Hoffmann-La Roche Ltd, and Biogen.
A.I. has received lecture fees/research grants and has been a member of advisory boards for Eisai and Shionogi. He has also received lecture fees from, and has been a member of advisory boards for, Janssen Pharmaceuticals, Chugai-Roche, and Merck Sharp & Dohme. He has also received lecture fees and research grants from Otsuka Pharmaceutical Co., Ltd., Daiichi Sankyo Company, Ltd., and Ono Pharmaceutical Co., Ltd. He has also received lecture fees from Kyowa Kirin Co., Ltd., and UCB Japan. He has also received research grants from AbbVie, Dainippon Sumitomo, the Japan Agency for Medical Research and Development, and the Japan Society for the Promotion of Science.
R.N. has received fees paid by a commercial entity (honoraria) for consultation from Biogen Inc., F. Hoffmann-La Roche Ltd., and Janssen Pharmaceuticals.
L.T.T. has received research grant support from the Alzheimer’s Association and the National Institutes of Health. He has also given talks for Sandoz, Torrent Pharmaceuticals Ltd., written texts for Genom, and participated in events for Sandoz and Torrent Pharmaceuticals Ltd.
F.V. has no competing interests to disclose.
M.T. is a full-time employee of, and owns shares in, F. Hoffmann-La Roche Ltd.
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References
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