INDIANAPOLIS—Researchers at Indiana University School of Medicine will play key roles in a national consortium led by Wake Forest University School of Medicine to study the use, interpretation and implementation of biomarkers to diagnose Alzheimer’s disease.
The multi-institution effort is funded by a five-year, $9 million grant from the National Institute on Aging, part of the National Institutes of Health, that will establish the Alzheimer’s Diagnosis in Older Adults with Chronic Conditions (ADACC) Network.
IU School of Medicine’s Nicole Fowler, PhD, MHSA, an associate professor of medicine at the school, will serve as co-principal investigator of the study.
“We are in a new era of using biomarkers to identify people who may be at risk of developing Alzheimer’s disease, yet the guidance for when to use and how to interpret these biomarkers in real-world populations has not been established,” Fowler said.
According to the Alzheimer’s Association, more than 6.5 million Americans are living with Alzheimer’s disease, and around 60% of older adults who have the disease or related dementias also have three or more chronic conditions, such as kidney disease, diabetes and obesity. These conditions make a diagnosis challenging.
“It is crucial that we develop an evidence-base to measure how Alzheimer’s disease biomarkers express in older people and diverse populations who are at risk of developing AD and have a greater prevalence of comorbid diseases and geriatric syndromes,” Fowler said. “This new consortium will begin to develop this evidence base.”
The Alzheimer’s Diagnosis in Older Adults with Chronic Conditions (ADACC) Network will be comprised of multiple sites and a multi-disciplinary team of investigators led by principal investigator Michelle M. Mielke, PhD, professor of epidemiology and prevention at Wake Forest. In addition to Fowler, other co-investigators of the study are Jeff Williamson, MD, professor of gerontology and geriatric medicine at Wake Forest, and Thomas K. Karikari, PhD, assistant professor of psychiatry at the University of Pittsburgh.
The network will have three primary objectives:
- Establish a data coordinating center to identify and assemble existing Alzheimer’s disease and related dementias observational and real-world cohorts, representative of older adults living with multiple chronic conditions.
- Examine the performance and accuracy of the blood biomarkers in older adults with multiple chronic conditions.
- Develop recommendations for how and when blood biomarkers should be used in primary care in older adults with multiple chronic conditions for the diagnosis of Alzheimer’s disease and related dementias.
Current biomarkers to detect the build-up of abnormal amyloid protein in the brain—a key hallmark of Alzheimer’s disease—include a lumbar puncture to test for proteins in cerebrospinal fluid (CSF) or amyloid Positron Emission Tomography (PET) imaging. These biomarkers, however, are more costly and invasive than a blood draw and are often not readily accessible.
Alzheimer’s disease blood biomarkers are becoming more available for clinical use, but it is not known how to incorporate them to establish a diagnosis in primary care and when additional confirmation such as CSF or PET is needed. More research is needed on how and when blood-based biomarkers should be used, especially among diverse populations of older adults.
Jeff Dage, PhD, senior research professor of neurology and a primary member of Stark Neurosciences Research Institute at IU School of Medicine, will provide his expertise in biomarkers of Alzheimer’s disease to the consortium. Dage, who is also the scientific director of the IU School of Medicine-led National Centralized Repository for Alzheimer’s and Related Dementias (NCRAD) Biomarker Assay Lab, has led the discovery and development of phosphorylated tau (P-tau) as a novel blood biomarker for Alzheimer's disease—a breakthrough that has identified Alzheimer's disease pathology and identified people at an increased risk of future cognitive decline.
“This is a challenging and rewarding research area that requires collaboration and innovation across disciplines and settings,” Dage said. “I’m thrilled about the opportunity the consortium presents because it can make a difference in the quality of life and care of many people affected by this devastating condition.”
Other IU School of Medicine researchers involved in the consortium include Sophia Wang, MD, MS, the Wesley P. Martin Scholar in Alzheimer’s Education; Naazneen Khan, PhD, assistant research professor of neurology; and Shannon Risacher, PhD, associate professor of radiology and imaging sciences.
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