In my previous post, I discussed the fact that Alzheimer’s disease traditionally has been viewed as a one-size-fits-all medical condition. An important new perspective would be to re-think and re-frame Alzheimer’s disease as a spectrum disorder, much like the evolution of re-thinking and reframing autism to autism spectrum disorder. Considering Alzheimer’s as a spectrum disorder sets the stage for the application of one of the most promising and innovative approaches in modern medicine, personalized, precision medicine.
Precision medicine, sometimes called personalized medicine, refers to the tailoring of medical treatment to the individual characteristics of each patient. Several core components of precision medicine have been identified, including comprehensive risk assessment, tools for early detection of pathological processes, and interventions tailored to an individual’s drivers of disease. These components, and others, speak to the potential power that precision medicine could have both in identifying specific profiles of Alzheimer’s disease, and, in turn, developing more effective interventions and treatments that can be targeted at specific aspects of the disease, and that can be personalized to individualized treatment.
Considerable research on Alzheimer’s disease is focused on understanding genetic risk. Indeed, a core component of precision medicine are tools for early detection of pathological processes, including genetic mutations and changes, and other approaches that focus on the molecular level, including discoveries of a range of identified biomarkers.
However, it is likely that environmental factors also will be key to risk assessment and to understanding and developing the most effective interventions. For example, it is well known that traumatic head injury increases the risk for Alzheimer’s. There are now established protocols for treating traumatic head injury, as well as individual counseling protocols to reduce future risk in cases of traumatic head injury. These include patient management and frequency of surveillance for preclinical AD. While treatment options for head injury, and for other risk factor conditions, can alter the course of vulnerability to Alzheimer’s for some individuals, it is less effective for others. Precision medicine can begin to help us understand why by uncovering how head trauma might interact with existing but undetected or latent pathophysiological processes and certain genetic dispositions that aim some individuals toward AD vulnerability.
Most recently, an additional effective strategy in precision medicine has been recognition of the potential impact of behavioral assessment tools, because they link so directly to the most obvious defining characteristic of Alzheimer’s, i.e., cognitive decline.
New and innovative behavioral assessment approaches have been developed and aimed at preclinical detection of oncoming cognitive decline based on our understanding of the underlying neurology of memory function. These behavioral assays are fast becoming part of precision medicine approaches because of the ability of these assays to selectively target dysfunction in particular brain regions and even identify specific brain structures. This kind of behavioral information will become invaluable in uncovering the relationships between symptoms in preclinical and established Alzheimer’s disease, the potential biomarkers, genetic markers, and pathophysiologic processes that underlie the disease.
The time is ripe for the convergence of two ideas, i.e., reframing Alzheimer’s disease as a spectrum disorder, and the application of personalized, precision medicine to Alzheimer’s disease as a spectrum disorder. We must come to the realization that there are many profiles of Alzheimer’s disease. The application of precision medicine will be the most effective and efficient way for us to discover and unpack the underlying neurology and genetics of Alzheimer’s profiles so that effective individualized treatments and interventions can be developed. In my next post, I’ll discuss additional behavioral interventions that could turn out useful not for predicting oncoming cognitive decline, but instead for more effectively managing individuals who are already affected by Alzheimer’s disease.