Expanding ventricles may detect preclinical Alzheimer disease

Although there are no treatments that slow the progression of Alzheimer disease (AD), therapies aimed at brain amyloid or at other mechanisms are in trials. It will be important to start treatment early in the process to prevent cognitive decline, emphasizing the importance of identifying AD at the earliest stage possible. Early detection of AD may be possible because asymptomatic subjects have amyloid plaques, intraneuronal tangles, and neurodegeneration.1 PET scanning with C-11 Pittsburgh compound B2 found evidence for amyloid accumulation in the brain of about 20% of healthy elders, FDG PET and MRI changes have been described in asymptomatic cognitively normal subjects, which seem to “predict” future cognitive decline and conversion to AD,3 and amyloid, tau, and other biomarkers in CSF of cognitively normal subjects also suggest early AD.4 None of these biomarkers is closely or directly correlated with neuronal loss. Subjects with AD have less brain tissue in the hippocampus5 and other brain regions,6 associated with ventricular enlargement.7 …

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