Do we treat dementia of the Alzheimer type or Alzheimer's disease? Anti-dementia drugs in the era of biomarkers

Abstract

Approved drug treatments for Alzheimer´s disease (AD) are symptomatic and don´t modify the disease course. These include acetylcholinesterase inhibitors (AchI) and N-methyl-D-aspartate receptor antagonist, memantine. Around 20 years ago, these drugs were approved for Alzheimer type Dementia. This wasbased on clinical trials which inclusion criteria were focused on a clinical amnestic AD presentation. At that time, subjects with an atypical AD clinical presentation or biomarkers were not included in the pharmacological trials. New biomarkers that detect amyloid and neurodegeneration have allowed us to evaluate pathological changes compatible with AD. These new advances from aclinical and biomarkers perspective allowed a diagnostic criteria update; going from an exclusively clinical criteria to one that is hybrid: clinical presentation and biomarkers based criteria. New biomarkers facilitate the early diagnosis of AD and other dementias. However, they also generate new challenges and questions regarding the adequate pharmacological reatment.There is a need for clinical trials that  evaluate anti-dementia drug’s efficacy based on current diagnostic criteria (clinical profile and biomarkers) and new practice guidelines. In addition, regulatory authorities should update ACHI and memantine indications. This will help doctors to prescribe the best possible treatment for this specificpopulation without increasing risks.