Projects / Programmes
Early detection and rational therapy of dementia: role of biomarkers
| Code |
Science |
Field |
Subfield |
| 3.03.00 |
Medical sciences |
Neurobiology |
|
| Code |
Science |
Field |
| B640 |
Biomedical sciences |
Neurology, neuropsychology, neurophysiology |
| Code |
Science |
Field |
| 3.02 |
Medical and Health Sciences |
Clinical medicine |
Dementia, Mild Cognitive Impairment, Parkinson's disease, Mild Cognitive Ipairment in Parkinson's disease
Researchers (27)
Organisations (1)
Abstract
One of the most prominent medical, social and economic problems in the 21 century is dementia. The prevalence of dementia ranges from 1% in the population between 60 and 65 years, up to 48 % in the population above 95%. More than 30 000 patients suffer from dementia in Slovenia. Studies in Alzhemier's disease (AD) have suggested a long preclinical phase before cognitive functions start to decline, leading to mild cognitive impairment (MCI) and subsequently, in many cases, to fully established dementia.The prevalence of MCI varies among different studies (depending on the age, criteria, and neuropsychological tests used) ranging from 3,2% up to 19 %. To facilitate the development of therapies aimed at preventing or delaying the progression of AD, research has focused on the search for sensitive, non-invasive, in vivo biomarkers that would enable earlier, more accurate clinical diagnosis and aid in monitoring disease progression and the effectiveness of therapeutic intervention. The aim of the study is to study different biomarkers(neuroimaging, CSF, neuropsychological, neurophysiological, olfactory impairment) in patients with MCI, PD and PD-MCI. 80 subjects will be included in the study: 20 patients diagnosed with MCI, 20 patients with PD, 20 patients with PD-MCI and 20 controls. All patients will undergo clinical evaluation, imaging studies, neuropsychological testing, electrophysiological investigation, CSF analyses and smell testing in the beginning and approximately one year of thereafter.
Significance for science
It became obvious in the last few years that neurodegenerative diseases (such as Alzheimer’s disease, Parkinson’s disease) start years or even decades before the first clinical symptoms occur. At the moment there are efficacious symptomatic treatments to alleviate Parkinson’s disease but not dementia. Therefore many research groups and laboratories all over the world work enthusiastically on a search for biomarkers that could show the start and pre-clinical development of the disease as early as possible. The present project reflects those efforts. The study included patients which – either as part of Parkinson’s disease or seemingly in good health – already complain about impaired memory (mild cognitive impairment and Parkinson’s disease associated with mild cognitive impairment). Recent scientific results demonstrate that possibly more than a third of mild cognitive impairment patients may evolve to Alzheimer’s dementia. Results for PD- mild cognitive impairment are even less clear. By studying patients with very early stage of cognitive impairment, the present research project responded to the needs of experimental and clinical neurology; and choosing the range of appropriate methods (good clinical examination, detailed neuropsychological testing, most recent imaging techniques such as functional MRI, diffusion tensor MRI and PET) increased the possibility of detecting such biomarkers in the earliest possible stages of the disease. Results clearly show that for early diagnosis of mild dementia, mild cognitive impairment, and subjective cognitive impairment a combination of imaging, electrophysiological, neuropsychological and biochemical biomarkers may be the most appropriate approach. The relevance of this research was confirmed with several papers (published or in press) in high-impact journals. (NeuroImage, ISSN 1053-8119, 15 May 2014, vol. 92, str. 27-35, J Geriatr Psychiatry Neurol. 2015 Mar;28(1):40-8., Dement Geriatr Cogn Dis Extra. 2014 Nov 11;4(3):419-30., Neuroimage Clin. 2014 Aug 28;6:115-25., European journal of neurology, ISSN 1351-5101, 2012, vol. 19, Acta psychologica, 2015, 156, str. 45-56., Neuroscience Letters, in press)
Significance for the country
The European and Slovenian population is aging quickly and therefore neurodegenerative diseases of the brain, among them Alzheimer's and Parkinson's disease, are fast becoming preeminent health-care concerns. The costs for these diseases for Slovenia are exceptional. The cumulative cost of brain diseases in Slovenia for 2010 are estimated at 2,425 billion EUR, adjusted for buying power parity (BPP), which represents 7% of gross domestic product. The biggest share goes to direct health-care costs (42,3%), followed by indirect costs (35,7%) and direct non-health-care costs (22,0%). Direct health-care costs for brain diseases account for 32% of all direct health-care costs in Slovenia. A breakdown of total disease-related health-care costs for Slovenia reveals that dementia costs and Parkinson's disease costs amount to 214,9 and 36,1 million EUR (BPP), respectively. Beside these economic indices one should not neglect psychological burden for the carers as well as for the whole family and destruction of the social net, from the moment when disease becomes clinically manifest. It would be possible to decrease economic, psychological and social burdens if the disease were recognized and diagnosed as soon as possible – at least when first clinical signs occur if not already in the years or decades when the disease is present pathologically but not yet expressed clinically. Indeed the study of biomarkers can provide us with such early diagnostic possibilities. The present research definitely demonstrates that already in pre-stages of clinically expressed dementia – in patients with mild cognitive impairment and Parkinson’s disease as well as with patients with pure mild cognitive impairment – it is possible to detect clear abnormalities. Future research should define recognizable patterns and typical profiles of patients with are about to develop a certain type of cognitive disorder and will need to be treated with a certain specific drug. An important outcome of the research group’s work is reflected also in active work for the national plan for dementia (Ministry of Health), in a successful application for the project “Živeti z Demenco” (Living with Dementia) for the Norwegian fund and a successful application for the first stage of the European TEAMING project ARTEMIDA, which already enables us to send Slovenian neurologists and neurology registrars to Karolinska Institutet (Stockholm, Sweeden). One of the important consequences of this research project was establishment of the Laboratory for Cognitive Neuroscience and of the Research Unit at the Department of Neurology, University Clinical Centre Ljubljana.
Most important scientific results
Annual report
2011,
2012,
2013
complete report on dLib.si
Most important socioeconomically and culturally relevant results
Annual report
2011,
2012,
2013
complete report on dLib.si
