Table 1 Treatment strategies in Alzheimer’s disease
Drug/intervention | Population | Selected volunteers |
|---|---|---|
Advantages | Large number of treated subjects | Targeted intervention |
Easier to identify (no biomarker required) | Evidenced pathophysiological mechanisms (biomarkers) | |
Larger benefit at the individual level | ||
Disadvantages | Cost of intervention (necessity of large intervention in terms of subject number and duration to obtain a benefit at the population level) | Limited number of subjects |
Frail population | Necessity of biomarkers (availability, acceptability, standardization) | |
Diagnostic uncertainty | Cost of biomarkers (for example, amyloid imaging) | |
Variability of size effect | Strength of evidence is highly dependent on the validity of pathophysiological hypothesis | |
Proposal for future treatment strategies | Symptomatic treatments for clinical (mild to severe) stages of Alzheimer’s disease | Tailored intervention for prodromal and very mild Alzheimer’s disease |
Prevention (multidomain intervention) | This kind of targeted prevention study using expensive treatment interventions and outcome measures could serve as proof of concept to stimulate cheaper interventions | |
Biomarkers could be considered as outcome for evaluating the impact on disease-relevant pathophysiology |