Washington University Researchers Develop New Tool That May Predict Risk of Alzheimer's

Researchers at Washington University School of Medicine in St. Louis have created an algorithm that can help inform people of their potential risk of developing dementia because of Alzheimer's disease. The algorithm uses demographic data, the results of brain imaging tests, and genetic biomarkers.

The research results published Sept. 30, 2022, in the Journal of Alzheimer's and Dementia, show that study participants may learn about their future risk of developing dementia. Researchers with the university's Knight Alzheimer Disease Research Center (Knight ADRC) say that this research also may help others in the future determine whether they face a risk of memory loss.

Principal investigator Sarah M. Hartz, MD, Ph.D., an associate professor of psychiatry at Washington University, says thousands of people have volunteered for studies at Alzheimer's research centers around the country.

They come back and undergo tests year after year, including PET (positron emission tomography) and MRI scans, blood draws, cognitive tests, and lumbar punctures that measure proteins in spinal fluid. Those studies advance the overall understanding of Alzheimer's disease, but they give participants relatively little information about their own risk. This algorithm is a way to help illuminate that information and to let individuals know whether they have a significant risk for dementia related to Alzheimer's disease.

Hartz and co-principal investigator Jessica Mozersky, Ph.D., an assistant professor of medicine in the university's Bioethics Research Center, examined the various factors contributing to Alzheimer's dementia. They used that information to create an algorithm to estimate an individual's absolute risk of developing early symptoms of dementia from Alzheimer's.

They developed the algorithm for use in a clinical trial to learn whether they could help volunteers participating in aging studies understand what biomarkers for the disease they might have and whether researchers could then evaluate participants' eventual outcomes.

Professor Mozersky says they have developed the algorithm because study participants wanted more than just a report of whether their test results were normal or abnormal.

We've performed studies with people who receive results reporting elevated amyloid, for example. They tell us, 'You know what I really want to know? My risk.'

Because there are currently no medications available to prevent or cure Alzheimer's, there have been ongoing ethical discussions regarding how much information to divulge to participants in these trials.

Plus, researchers say that no matter how well various biomarkers predict the problem in people with no symptoms, it has still been well studied.

"We developed the algorithm so that we can tell participants what currently is known in a meaningful way, and so that the algorithm can be updated easily as new research or data emerges," Hartz said.

The algorithm, accessible on the Knight ADRC's website -  https://alzheimerdementiacalculator.wustl.edu/.

It provides greater detail for researchers and individuals who want to learn more about Alzheimer's dementia risk. 

For example, a 69-year-old woman who went to college and had a parent with dementia from Alzheimer's has about a 6% risk of developing the early symptoms of Alzheimer's dementia in the next five years. That means she also has a 94% chance of not developing dementia from Alzheimer's in the next five years.

Professor Hartz says one thing is still the most significant risk factor for Alzheimer's.

Age is the biggest demographic risk factor.

According to the National Institute on Aging, Alzheimer's disease is a brain ailment that gradually erodes memory and thinking abilities and the capacity to do even the most basic tasks. In most people with Alzheimer's, symptoms first appear later in life. 

Individuals with Alzheimer's experience different initial symptoms. For many, the very early stages of the disease may be indicated by a reduction in non-memory cognitive abilities, such as word finding, vision/spatial difficulties, and impaired thinking or judgment.

As the disease progresses, individuals with Alzheimer's will require supervision. Over time, they will also need help with everyday living activities. This care is often initially provided by family members, usually a daughter or daughter-in-law who takes off work to provide care. Many families are unaware that health insurance and Medicare pay almost nothing toward most long-term health care, including dementia care.

Professional caregivers may be brought in if the person has enough income and savings to pay for the care - or has Long-Term Care Insurance. Medicaid is available for those with little or no income and assets.

LTC Insurance can only be purchased when someone has relatively good health. Most people obtain coverage in their 50s; waiting until dementia starts will make the insurance unavailable.