Alzheimer's Disease & Dementia CE/CME ACCREDITED Watch Time: 34 mins

touchTALKS Recent advances in neuroimaging technologies and future directions for early assessment and monitoring in Alzheimer’s disease

Watch behavioural neurologist and neuroscientist Dr Brad Dickerson discuss recent advances and future directions in neuroimaging technologies in Alzheimer’s disease.

 
Video Chapters
How can neuroimaging modalities help with early and accurate diagnosis of Alzheimer’s disease?

Dr Brad Dickerson discusses the rationale for early diagnosis, including the impact of potential disease-modifying therapy on clinical practice in patients with early Alzheimer’s disease and an overview of neuroimaging technology and guidelines for diagnostic criteria.

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What are the recent advances in neuroimaging technologies and how can they be implemented in practice?

Dr Brad Dickerson provides an overview of PET and MRI technologies and their potential use in Alzheimer’s disease, including practical implementation in imaging centres and the future role of neuroimaging in Alzheimer’s disease.

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What is the role of neuroimaging biomarkers for patient diagnosis, selection and monitoring in Alzheimer’s disease?

Dr Brad Dickerson discusses the potential application of neuroimaging biomarkers for precision medicine approaches in Alzheimer’s disease in the context of the current clinical trials, including Aβ PET imaging for preclinical diagnosis and the role in monitoring of amyloid-related imaging abnormalities.

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Overview & Learning Objectives
Overview

In this activity, behavioural neurologist and neuroscientist Dr Brad Dickerson discusses recent advances in neuroimaging technologies and future directions for early assessment and monitoring in Alzheimer’s disease.

This activity has been jointly provided by Oakstone and touchIME NEUROLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians. read more

Target Audience

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

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest have been mitigated. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relationships with ineligible entities.

Faculty

Dr Brad Dickerson discloses: Consulting fees from Acadia, Alector, Arkuda, Axovant, Biogen, Eisai, Life Molecular Sciences, Lilly, Merck, Novartis and Wave Life Sciences. Editorial duties at Elsevier (Neuroimage: Clinical and Cortex). Research support from Alzheimer’s Drug Discovery Foundation and National Institutes of Health. Royalties from Cambridge University Press and Oxford University Press.

Content reviewer

Walter Murray Yarbrough, MD, FACP has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Sola Neunie has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

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 the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

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 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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

Date of original release: 07 June 2021. Date credits expire: 07 June 2022.

Learning Objectives

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

  • Recognize the importance of early and accurate diagnosis in AD and consider evidence-based guidelines supporting the use of neuroimaging techniques to confirm the diagnosis
  • Review recent advances in neuroimaging techniques and their practical application in the current and future management of AD
  • Discuss the use of neuroimaging biomarkers for patient diagnosis, selection and monitoring in clinical trials and in the future management of AD

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About Dr Brad Dickerson
Dr Brad Dickerson

Harvard Medical School, Boston, MA, USA

Brad Dickerson is a behavioural neurologist and neuroscientist dedicated to the sophisticated, compassionate and multidisciplinary care of patients with neurodegenerative disorders, including Alzheimer’s disease and frontotemporal dementia. He is Director of the MGH Frontotemporal Disorders Unit, Tommy Rickles Endowed Chair in Progressive Aphasia Research, Director of the Neuroimaging Core of the MGH Alzheimer’s Disease Research Center, and a Professor of Neurology at Harvard Medical School. read more

Dr Dickerson runs a large, multidisciplinary team of more than 25 clinicians and scientists using advanced brain imaging and behavioural methods to study how memory, language, emotion and social behaviours change in normal aging and in patients with neurodegenerative disease, with active funding from the National Institutes of Health.

He has published more than 200 articles in peer-reviewed scientific journals as well as many book chapters, and has edited two books on dementia. He is active in mentoring trainees and in teaching, including co-directing the annual Harvard Dementia Course. He is Chair of the Medical and Scientific Advisory Council of the Massachusetts Alzheimer’s Association and is Chair-Elect of the national Medical Advisory Council of the Association for FTD. He has won a number of awards, including the American Academy of Neurology’s Norman Geschwind Award in Behavioral Neurology.

Dr Brad Dickerson discloses: Consulting fees from Acadia, Alector, Arkuda, Axovant, Biogen, Eisai, Life Molecular Sciences, Lilly, Merck, Novartis and Wave Life Sciences. Editorial duties at Elsevier (Neuroimage: Clinical and Cortex). Research support from Alzheimer’s Drug Discovery Foundation and National Institutes of Health. Royalties from Cambridge University Press and Oxford University Press.

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Question 1/5
A double-blind, placebo-controlled phase Ib randomized trial reported which of the following in patients with Alzheimer’s disease treated with aducanumab at week 54?

CDR-SB, Clinical Dementia Rating—Sum of Boxes; MMSE, Mini-Mental State Examination.
Correct

In the trial, patients with Alzheimer’s disease had a mean PET standard uptake value ratio composite score at baseline of 1.44. After 54 weeks of treatment, this had decreased significantly (p<0.001) in the ≥3 mg/kg aducanumab arms compared with the placebo arm.

PET, positron emission tomography.

Reference

Sevigny J, et al. Nature. 2016;537:50–6.

Question 2/5
You want to identify whether your patient with Alzheimer's disease has any regional atrophy. Which of the following methodologies would you use?

FDG-PET, fluorodeoxyglucose-positron emission tomography; MRI, magnetic resonance imaging; SPECT, single-photon emission computed tomography.
Correct

Neuroimaging, such as CT or MRI, are important in ruling out physical pathology and may also identify temporo-parietal atrophy in patients with Alzhemier’s disease. SPECT or FDG-PET may be helpful in identifying regional function reduction such as focal hypoperfusion or hypometabolism in the temporo-parietal cortices.

CT, computerized tomography; FDG-PET, fluorodeoxyglucose-positron emission tomography; MRI, magnetic resonance imaging; SPECT, single-photon emission computed tomography.

Reference

Byrne A, Prichard J. Prog Neurol Psychiatry. 2018;22:31–5.

Question 3/5
A 70-year-old man is suffering from paraphasias, memory and orientation problems. The patient was assessed with neuropsychometric tests, auditory event-related potentials and cerebrospinal fluid protein analysis, and was diagnosed with MCI. A neurodegenerative disorder is suspected to be the underlying cause of the MCI and you are further assessing the patient using FDG-PET. Following the EANM/EAN recommendations for
FDG-PET, which of these differential diagnoses can you make using this imaging methodology?

EAN, European Academy of Neurology; EANM, European Association of Nuclear Medicine;
FDG-PET, fluorodeoxyglucose-positron emission tomography; MCI, mild cognitive impairment.
Correct

The 2018 EANM and EAN recommendations for FDG-PET support the following differential diagnoses:

  • between dementia with Lewy bodies and Alzheimer’s disease
  • between Alzheimer’s disease and frontotemporal lobar degeneration
  • between dementia with Lewy bodies and frontotemporal lobar degeneration
  • between Alzheimer’s disease and vascular dementia

EAN, European Academy of Neurology; EANM, European Association of Nuclear Medicine;
FDG-PET, fluorodeoxyglucose-positron emission tomography.

Reference

Nobili F, et al. Eur J Neurol. 2018;25:1201–17.

Question 4/5
Assuming future approval, some of your patients with early Alzheimer’s disease are being treated with low dose (titrated to 3 or 6 mg/kg) aducanumab. What proportion of your patients would you expect to experience side effects to this treatment?
Correct

The phase III EMERGE and ENGAGE trials of aducanumab reported adverse event rates in the low-dose arms of 7.6% and 7.9%, respectively.

Reference

Haeberlein SB, et al. Biogen Presentation AAT-AD/PD, Vienna, Austria. April 2020. Available at: https://investors.biogen.com/static-files/f91e95d9-2fce-46ce-9115-0628cfe96e83 (accessed April 2021).”

Question 5/5
Assuming future approval, you are treating a patient with early, symptomatic Alzheimer’s disease with donanemab. Considering the results of the phase II clinical trial of donanemab in participants with early Alzheimer's disease, which of the following changes from baseline to 76 weeks would you expect to see in your patient?

MRI, magnetic resonance imaging; PET, positron emission tomography.
Correct

At 76 weeks, the phase II clinical trial reported a reduction in the amyloid plaque level in patients with early Alzheimer’s disease as assessed by florbetapir PET of 85.06 centiloids in the donanemab group compared with in the placebo group (95% confidence interval, -92.68 to -77.43).

PET, positron emission tomography.

 

Reference

Mintun MA, et al. N Engl J Med. 2021;384:1691–704.

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