Magazine article Clinical Psychiatry News

Tau Imaging Predicts Looming Decline in Cognitively Normal

Magazine article Clinical Psychiatry News

Tau Imaging Predicts Looming Decline in Cognitively Normal

Article excerpt


BOSTON -- Progressive tau accumulation in the temporal lobe of cognitively normal older adults was associated with cognitive decline over time in a prospective, longitudinal study presented at the Clinical Trials on Alzheimer's Disease conference.

This track of cognitive impairment following tau pathology in a preclinical Alzheimer's disease (AD) population suggests two roles for serial positron-emission tomography (PET) scans with a tau binding agent, Bernard Hanseeuw, MD, PhD, said at the meeting. In the near future, they could be used to track therapeutic response in clinical trials. Farther out, if future validation studies confirm these preliminary results, they might be a useful clinical tool for predicting how fast an individual Alzheimer's patient will progress, he said in an interview.

"Tau imaging will be a very important way to track disease progression," said Dr. Hanseeuw of the Gordon Center for Medical Imaging at Massachusetts General Hospital, Boston. 'Amyloid imaging is excellent to detect AD pathology, but it's not the perfect way to track the progression of disease, because it changes little over 2-3 years."

Serial tau scans, however, would, he said.

"Every patient with Alzheimer's disease is different, with a different disease course. Amyloid scans can tell us if someone is on the wrong path, but tau scans could tell us how fast they are going. If you have Alzheimer's, it's important to know if you may not be able to live in your own home in a year. With tau PET, we could track the disease and predict how fast it might evolve," Dr. Hanseeuw said.

Tau imaging remains investigational only. Several tau imaging agents are being developed, but none has yet been approved in the United States or in Europe.

To investigate the correlation of tau and cognitive decline in preclinical Alzheimer's, Dr. Hanseeuw examined serial tau and amyloid PET scans conducted on 60 clinically normal older adults with a mean age of 75 years. About one-third of the cohort was positive for the APOE4 allele. All of them had a baseline Clinical Dementia Rating (CDR) score of 0 and a mean Mini-Mental State Exam score of at least 27. They also scored in the normal range on the Preclinical Alzheimer's Cognitive Composite (PACC) test. This relatively new cognitive scale is an increasingly popular item in clinical trials. The PACC is a composite of the WAIS-R Digit Symbol Substitution Test, Mini-Mental State Exam, Free and Cued Selective Reminding Test, and Logical Memory IIA Delayed Recall, and correlates well with amyloid accumulation in the brain. …

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