Skip to main content

Table 1 Treatment strategies in Alzheimer’s disease

From: Should interventions to treat or prevent Alzheimer’s disease be tested in a population or as targeted treatment of highly selected study participants?

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