Alzheimer's Disease & Dementia CE/CME ACCREDITED Watch Time: 110 mins

touchSATELLITE SYMPOSIUM Blood-based biomarkers: Supporting the diagnosis and treatment of Alzheimer’s disease

Watch Professors Jeffrey Cummings, Liana Apostolova, Oskar Hansson and Charlotte Teunissen discuss the use of blood-based biomarkers in Alzheimer’s disease during the live symposium at the AD/PD™ 2023 International Conference on Alzheimer’s and Parkinson’s Diseases and related neurological disorders.

Prof. Jeffrey Cummings

University of Nevada, Las Vegas, NV, USA

CHAIR

Panelists:
Prof. Liana Apostolova, Prof. Oskar Hansson, Prof. Charlotte Teunissen
Watch Time: 04:51

Prof. Jeffrey Cummings introduces this touchSATELLITE SYMPOSIUM on the importance of a timely and accurate diagnosis of Alzheimer’s disease, and how current diagnostic challenges and barriers may be addressed through the use of blood-based biomarkers.

 
Watch Time: 12:47

Prof. Liana Apostolova discusses the importance of a timely and accurate diagnosis based on the underlying pathophysiology of AD and how this informs the ATN classification system for AD biomarkers.

 
Watch Time: 14:41

Prof. Jeffrey Cummings poses questions from the live audience at AD/PD™ 2023 to Prof. Liana Apostolova. To view audience questions, please view the downloadable slides.

 
Watch Time: 16:05

Prof. Oskar Hannson reviews the validity and performance data for AD blood-based biomarkers in comparison to current neuroimaging.

 
Watch Time: 11:55

Prof. Jeffrey Cummings poses questions from the live audience at AD/PD™ 2023 to Prof. Oskar Hansson. To view audience questions, please view the downloadable slides.

 
Watch Time: 17:44

Prof. Charlotte Tuenissen looks at how blood-based biomarkers may revolutionize the diagnostic and prognostic work-up of AD and improve the design of interventional trials, with the potential to be easily accessible for widespread clinical use.

 
Watch Time: 11:06

Prof. Jeffrey Cummings poses questions from the live audience at AD/PD™ 2023 to Prof. Charlotte Teunissen. To view audience questions, please view the downloadable slides.

 
Watch Time: 20:35

In this interactive session, the panellists answer questions from the live audience at AD/PD™ 2023 and provide their expert perspectives on the use of blood-based biomarkers in AD.

 
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Overview & Learning Objectives
Overview

In this activity, leading experts in neurology come together at AD/PD™ 2023 to examine the importance of prioritizing a timely and accurate diagnosis of Alzheimer’s disease (AD) based on the underlying biology, and how current diagnostic challenges and barriers may be addressed through the use of blood-based biomarkers. The expert panel go on to discuss the latest clinical data supporting the use of blood-based biomarkers in the diagnosis and treatment of AD and look at how they may be incorporated into clinical practice to facilitate the diagnostic and prognostic workup of patients with AD for early disease management.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of neurologists, Alzheimer’s disease specialists and other HCPs involved in the management of Alzheimer’s disease.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Jeffrey Cummings discloses: Consultancy fees from Acadia, Actinogen, Alkahest, AlphaCognition, Aprinoia, AriBio Biogen, BioVie, Cassava, Cerecin, Corium, Cortexyme, Diadem, EIP Pharma, Eisai, Eli Lilly, GAP Innovation, GemVax, Genentech, Green Valley, Grifols, Janssen, Karuna, Lundbeck, LSP, Merck, NervGen, Novo Nordisk, Oligomerix, Ono, Optoceutics, Otsuka, PRODEO, Prothena, ReMYND, Resverlogix, Roche, Sage Therapeutics, Signant Health, Simcere, Sunbird Bio, Suven, TrueBinding and Vaxxinity Pharmaceutical. Other financial or material support from Neuropsychiatric Inventory copyright. Stock/shareholder (self-managed) from Acumen, Alzheon, Behrens, MedAvante-Prophase and Vaxxinity.

Prof. Liana Apostolova discloses: Consultancy fees from Biogen, Eisai, Eli Lilly, GE Healthcare, Genentech, IQVIA, Roche Diagnostics and Two Labs. Grants/research support from AVID Pharmaceuticals, Eli Lilly, Life Molecular Imaging and Roche Diagnostics. Speaker’s bureau fees from ASiM, Health and Hospitality Corporation and MillerMed. Stock/shareholder (self-managed) from Cassava Neurosciences and Golden Seeds.

Prof. Oskar Hansson discloses: Advisory board or panel fees from AC Immune, Alzpath, Amylyx, BioArctic, Biogen, Cerveau, Eisai, Eli Lilly, Fujirebio, Genentech, Merck, Novartis, Novo Nordisk, Roche, Sanofi and Siemens. Consultancy fees from AC Immune, Alzpath, Amylyx, BioArctic, Biogen, Cerveau, Eisai, Eli Lilly, Fujirebio, Genentech, Merck, Novartis, Novo Nordisk, Roche, Sanofi and Siemens. Grants/research support from ADx, AVID Radiopharmaceuticals, Biogen, Eli Lilly, Eisai, Fujirebio, GE Healthcare, Pfizer and Roche.

Prof. Charlotte Teunissen discloses: Grants/research support from AC-Immune, ADx Neurosciences, Axon Neurosciences, BioConnect, Bioorchestra, Brainstorm Therapeutics, Celgene, EIP Pharma, Eisai, Eli Lilly, Fujirebio, Grifols, Instant Nano Biosensors, Merck, Novo Nordisk, PeopleBio, Quanterix, Roche, Siemens, Toyama and Vivoryon. Speaker’s Bureau fees from Grifols, Novo Nordisk and Roche.

Content reviewer

Niraja S. Suresh has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 2.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 2.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 21 April 2023. Date credits expire: 21April 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recognize the importance of a timely and accurate biological diagnosis of AD to inform treatment decisions
  • Assess clinical data for diagnostic AD blood-based biomarkers and identify their advantages and limitations
  • Evaluate how blood-based biomarkers can be integrated into the diagnostic workup of patients and facilitate disease management
Faculty & Disclosures
Prof. Jeffrey Cummings

University of Nevada, Las Vegas, NV, USA

Jeffrey Cummings, MD ScD, is the Joy Chambers-Grundy professor of brain science, director of the Chambers-Grundy Center for Transformative Neuroscience, and co-director of the Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), USA. read more

Prof. Cummings is globally recognized for his contributions to Alzheimer’s disease research, drug development and clinical trials. He has been recognized for his research and leadership contributions in the field of Alzheimer’s disease through many awards, including the Ronald and Nancy Reagan Research Award of the National Alzheimer’s Association (2008), the Distinguished Scientist Award from the American Association of Geriatric Psychiatry, a Lifetime Achievement Award from the Society for Behavioral and Cognitive Neurology, the Bengt Winblad Lifetime Achievement Award from the Alzheimer’s Association, and the Alzheimer’s Drug Discovery Foundation’s Melvin R. Goodes Prize.

Prof. Cummings was formerly director of the Mary S. Easton Center for Alzheimer’s Disease Research at UCLA and director of the Cleveland Clinic Lou Ruvo Center for Brain Health. His interests embrace clinical trials, developing new therapies for brain diseases, and the interface of neuroscience and society. Prof. Cummings has authored or edited 43 books and published over 800 peer-reviewed papers.

Prof. Jeffrey Cummings discloses: Consultancy fees from Acadia, Actinogen, Alkahest, AlphaCognition, Aprinoia, AriBio Biogen, BioVie, Cassava, Cerecin, Corium, Cortexyme, Diadem, EIP Pharma, Eisai, Eli Lilly, GAP Innovation, GemVax, Genentech, Green Valley, Grifols, Janssen, Karuna, Lundbeck, LSP, Merck, NervGen, Novo Nordisk, Oligomerix, Ono, Optoceutics, Otsuka, PRODEO, Prothena, ReMYND, Resverlogix, Roche, Sage Therapeutics, Signant Health, Simcere, Sunbird Bio, Suven, TrueBinding and Vaxxinity Pharmaceutical. Other financial or material support from Neuropsychiatric Inventory copyright. Stock/shareholder (self-managed) from Acumen, Alzheon, Behrens, MedAvante-Prophase and Vaxxinity.

Prof. Liana Apostolova

Indiana University School of Medicine, Indianapolis, IN, USA

Liana Apostolova, MS, MD, FAAN, is professor of neurology, radiology, and medical and molecular genetics and the Barbara and Peer Baekgaard chair in Alzheimer’s disease research at Indiana University School of Medicine, Indianapolis, IN, USA. Prof. Apostolova’s research explores the intersection of cognition, neuroimaging, blood-based biomarkers and genetics. This work has established the potential for identifying those at risk for developing Alzheimer’s disease, and associations between Alzheimer’s disease genes and important disease pathways that could serve as a blueprint for developing new treatments. read more

She has served as the principal investigator (PI) or co-PI on studies funded by the NIH, AHA and the Alzheimer’s Association, and she is the PI of the Longitudinal Early-Onset Alzheimer’s Disease Study (LEADS). Prof. Apostolova has authored or co-authored over 100 scholarly articles and 15 book chapters. Her research awards include the AFAR‐GE Healthcare Junior Investigator Award for Excellence in Imaging and Aging Research, the AAN Research Award in Geriatric Neurology, the Dorothy Dillon Eweson Lectureship on the Advances in Aging Research, and the Alzheimer’s Association de Leon Prize in Neuroimaging (senior scientist category). Prof. Apostolova is a fellow of the AAN and the editor-In-chief for Alzheimer’s and Dementia: Diagnosis, Assessment and Disease Monitoring.

Prof. Liana Apostolova discloses: Consultancy fees from Biogen, Eisai, Eli Lilly, GE Healthcare, Genentech, IQVIA, Roche Diagnostics and Two Labs. Grants/research support from AVID Pharmaceuticals, Eli Lilly, Life Molecular Imaging and Roche Diagnostics. Speaker’s bureau fees from ASiM, Health and Hospitality Corporation and MillerMed. Stock/shareholder (self-managed) from Cassava Neurosciences and Golden Seeds.

Prof. Oskar Hansson

Lund University, Lund, Sweden

Oskar Hansson, MD, PhD, is a senior consultant in neurology at Skåne University Hospital and full professor of neurology at Lund University in Sweden. He is also co-director of the strategic research area of neuroscience at Lund University, and is responsible for research at the Memory Clinic at Skåne University Hospital. read more

Prof. Hansson performs internationally recognized clinical and translational research on the early phases of Alzheimer’s and Parkinson’s diseases. His work on biomarkers has led to over 400 original peer-reviewed publications. He heads the prospective and longitudinal Swedish BioFINDER studies, where the research team focuses on the development of optimized algorithms for early diagnosis, and also studies the consequences of different brain pathologies on cognitive, neurologic and psychiatric symptoms in healthy individuals and patients with dementia and parkinsonian disorders. Recently, the BioFINDER team demonstrated that tau positron emission tomography imaging can, with high accuracy, distinguish Alzheimer’s disease from all other neurodegenerative diseases (2018), predict cognitive decline in cognitively normal individuals (2022) and detect different subtypes of Alzheimer’s disease (2021). Prof. Hansson has developed and validated blood-based biomarkers for early detection of Alzheimer’s disease (2020–2022).

Prof. Oskar Hansson discloses: Advisory board or panel fees from AC Immune, Alzpath, Amylyx, BioArctic, Biogen, Cerveau, Eisai, Eli Lilly, Fujirebio, Genentech, Merck, Novartis, Novo Nordisk, Roche, Sanofi and Siemens. Consultancy fees from AC Immune, Alzpath, Amylyx, BioArctic, Biogen, Cerveau, Eisai, Eli Lilly, Fujirebio, Genentech, Merck, Novartis, Novo Nordisk, Roche, Sanofi and Siemens. Grants/research support from ADx, AVID Radiopharmaceuticals, Biogen, Eli Lilly, Eisai, Fujirebio, GE Healthcare, Pfizer and Roche.

Prof. Charlotte Teunissen

Amsterdam University Medical Centers, Amsterdam, The Netherlands

Charlotte Teunissen, PhD, is professor of neurochemistry at Amsterdam University Medical Centers in The Netherlands. She is driven to improve the care of patients with neurological diseases by developing fluid biomarkers for diagnosis, stratification, prognosis and monitoring treatment responses. Studies from her research group span the entire spectrum of biomarker development, from identification, assay development and analytical validation, through to clinical validation and implementation in clinical practice. She has extensive expertise with assay development using state-of-the-art technologies and in implementation of in vitro diagnostic technologies for clinical routine lab analysis. read more

Prof. Teunissen is responsible for the large, well-characterized biobank of the Amsterdam Dementia cohort, containing >5,200 paired cerebrospinal fluid and serum samples of individuals visiting the memory clinic at the Alzheimer Center Amsterdam. In addition, she leads several collaborative international biomarker networks, such as the Society for CSF Analysis and Clinical Neurochemistry, and the Alzheimer’s Association Global Biomarker Standardization Consortium and Standardization of Alzheimer’s Blood Biomarkers Program. She is the coordinator of the Marie Curie MIRIADE project that aims to train 15 novel researchers in innovative strategies to develop dementia biomarkers, and the JPND bPRIDE project that aims to develop targeted blood-based biomarker panels for early differential diagnoses of specific dementias.

Prof. Charlotte Teunissen discloses: Grants/research support from AC-Immune, ADx Neurosciences, Axon Neurosciences, BioConnect, Bioorchestra, Brainstorm Therapeutics, Celgene, EIP Pharma, Eisai, Eli Lilly, Fujirebio, Grifols, Instant Nano Biosensors, Merck, Novo Nordisk, PeopleBio, Quanterix, Roche, Siemens, Toyama and Vivoryon. Speaker’s Bureau fees from Grifols, Novo Nordisk and Roche.

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CE/CME Test (2.0 Points) Close
CE/CME Test

To obtain the CME credit(s), please complete this post-test. Please complete and click to see your results and continue.

Question 1/5
Your 65-year-old male patient has suffered from short-term memory loss for the past 2 years. After a series of functional, behavioural and cognitive tests, your patient has been referred for CSF testing. CSF analysis shows normal levels of Aß42 and phosphorylated tau, and elevated levels of total tau and NfL. What clinical assessment would you make?

Aß, amyloid-beta; AD, Alzheimer’s disease; CSF, cerebrospinal fluid; NfL, neurofilament light chain.
Correct

According to the 2018 NIA-AA ATN Research Framework, biomarker evidence of Aß deposition alone with normal CSF levels of total and phosphorylated tau biomarkers would be assigned the label ‘Alzheimer’s pathologic change’. The term ‘Alzheimer’s disease’ would be applied if there is biomarker evidence of both Aß and phosphorylated tau. In this case, the patient has normal Aß levels but elevated levels of total tau and NfL, suggesting a ‘non-Alzheimer’s disease pathologic change’.

Abbreviation

Aß, amyloid-beta; NfL, neurofilament light chain; NIA-AA, National Institute on Aging and Alzheimer’s Association.

Reference

Jack CR Jr, et al. Alzheimers Dement. 2018;14:535–62.

Question 2/5
Which method for the robust and precise quantification of plasma Aβ and plasma tau outperforms all other assays?

Aβ, amyloid-beta; MSD, Meso Scale Discovery.
Correct

A head-to-head comparison of p-tau181, p-tau217 and p-tau231 measured using 10 different assays to detect abnormal brain Aβ status and predict future progression to Alzheimer’s dementia, found that mass spectrometry-based p-tau217 exhibited significantly better performance than all other plasma p-tau biomarkers when detecting abnormal Aβ status (AUC=0.947; 18 pdiff<0.015) or progression to Alzheimer’s dementia (AUC=0.932; pdiff<0.027).1

A further study, including 408 participants from two independent cohorts (BioFINDER and Alzheimer Disease Neuroimaging Initiative), found that plasma Aβ42/40 quantified using certain mass spectrometry-based methods showed better discriminative accuracy than immunoassays when identifying individuals with abnormal intracerebral Aβ status according to cerebrospinal fluid Aβ42/40 levels and Aβ PET.2

Abbreviations

Aβ, amyloid-beta; AUC, area under the curve; PET, positron emission tomography.

References

  1. Janelidze S, et al. 2022; doi: 10.1093/brain/awac333. Online ahead of print.
  2. Janelidze S, et al. JAMA Neurol. 2021;78:1375–82.
Question 3/5
How would you best use the plasma p-tau217 biomarker in preclinical Alzheimer’s disease?

Aβ, amyloid-beta; NfL, neurofilament light chain.
Correct

Research shows that plasma p-tau217 levels are elevated during the early preclinical stages of AD in participants who are Aβ-positive and cognitively unimpaired, before insoluble tau aggregates are detectable by tau-PET. These results suggest that p-tau217 may be useful as an early biomarker of AD.

Abbreviations

Aβ, amyloid-beta; AD, Alzheimer’s disease; PET, positron emission tomography.

Reference

Janelidze S, et al. JAMA Neurol. 2021;78:149–56.

Question 4/5
Which trial is currently using elevated plasma p-tau217 levels as part of its inclusion criteria?
Correct

Currently, only one trial, TRAILBLAZER-ALZ 3, evaluating the efficacy of donanemab in cognitively normal people with elevated plasma p-tau217, utilizes a blood-based biomarker in its inclusion criteria.1,2 This approach is based on the good discriminating performance established by the p-tau217 assay. This strategy seems particularly attractive for trials that include participants at the preclinical stage of Alzheimer’s disease, where participants are less likely to accept invasive diagnostic tests.1,2

References

  1. ClinicalTrials.gov. NCT05026866. Available at: www.clinicaltrials.gov/ct2/show/NCT05026866 (accessed 6 March 2023).
  2. Angioni D, et al. J Prev Alzheimers Dis. 2022;9:569–79.
Question 5/5
When discussing with colleagues the future role of blood-based biomarkers, how would you best implement blood-based biomarkers in primary care?

AD, Alzheimer's disease.
Correct

It is proposed that blood-based biomarkers may assist in the diagnosis and prognosis of Alzheimer’s disease in clinical practice. A possibility is to utilize blood-based biomarkers in primary care to assess Alzheimer’s disease risk and identify patients with cognitive impairment who would benefit from referral for further cognitive evaluation by specialists in memory disorders.

Reference

Angioni D, et al. J Prev Alzheimers Dis. 2022;9:569–79.

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