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Research ArticleSpecial Communication

The Potential Emergence of Disease-Modifying Treatments for Alzheimer Disease: The Role of Primary Care in Managing the Patient Journey

Jenny Lam, Jakub Hlávka and Soeren Mattke
The Journal of the American Board of Family Medicine November 2019, 32 (6) 931-940; DOI: https://doi.org/10.3122/jabfm.2019.06.180328
Jenny Lam
From the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA (JM); Price School of Public Policy, University of Southern California, Los Angeles, CA (JH); Center for Economic and Social Research, University of Southern California, Los Angeles, CA (SM).
MD, MAS
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Jakub Hlávka
From the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA (JM); Price School of Public Policy, University of Southern California, Los Angeles, CA (JH); Center for Economic and Social Research, University of Southern California, Los Angeles, CA (SM).
PhD
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Soeren Mattke
From the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA (JM); Price School of Public Policy, University of Southern California, Los Angeles, CA (JH); Center for Economic and Social Research, University of Southern California, Los Angeles, CA (SM).
MD, DSc
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    Figure 1.

    Biological model of Alzheimer disease.

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    Figure 2.

    Classification of patients in Alzheimer disease. MCI, mild cognitive impairment.

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    Table 1.

    Disease-Modifying Treatments for Alzheimer's Disease in Phase 2 and Phase 3 Clinical Trials

    CandidateClinical Trial PhaseExpected Primary Completion DateNational Clinical Trial Identifier
    Anti-Aβ antibodies
        GantenerumabPhase 3May-22NCT03443973, NCT03444870
        BAN2401Phase 3Jul-22NCT03887455
        LY3002813Phase 2Oct-20NCT03367403
    Anti-tau antibodies
        ABBV-8E12Phase 2Dec-20NCT02880956
        RO7105705Phase 2Sep-20NCT03289143
    BACE inhibitors
        Elenbecestat (E2609)Phase 3Jun-21NCT03036280
        CNP520Phase 2/3Jul-24NCT03131453
    Vaccines
        CAD106Phase 2/3Aug-24NCT02565511
        AADvac1Phase 2Jun-19NCT02579252
    • Aβ, amyloid-beta; BACE, Beta-secretase.

    • Clinical trial information was obtained from ClinicalTrials.gov as of June 27, 2019.

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    Table 2.

    Comparison of the Scoring of Cognitive Domains by the MMSE and MoCA

    Cognitive DomainMMSE (Maximum Score)MoCA (Maximum Score)
    Orientation: time and place106
    Registration3—
    Attention and concentration56
    Memory35
    Verbal fluency—1
    Language85
    Visuospatial abilities15
    Abstraction—2
    Total score3030
    • MMSE, Mini-Mental State Exam; MoCA, Montreal Cognitive Assessment.

    • View popup
    Table 3.

    Projected Impact of Diagnostic Testing on Demand for Specialty Evaluation

    Test for MCI Due to ADFalse Positives (in Millions)True Positives (in Millions)Number of Patients Requiring Specialty Referral (in Millions)Proportion of Referred Patients with Confirmed MCI Due to AD
    MMSE27.15.432.617%
    MMSE + plasma Aβ5.25.310.451%
    MoCA21.95.627.520%
    MoCA + plasma Aβ4.25.49.656%
    • Aβ, amyloid-beta; AD, Alzheimer disease; MCI, mild cognitive impairment; MMSE, mini-mental state exam; MoCA, Montreal Cognitive Assessment.

    • Patients with MCI due to AD have both MCI and evidence of Aβ deposition in the brain. We estimated that 10.7 million people in the 55+-year-old population in the United States in 2020 will have MCI. Of these, 6.6 million will also have evidence of Aβ deposition.

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The Journal of the American Board of Family     Medicine: 32 (6)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 6
November-December 2019
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The Potential Emergence of Disease-Modifying Treatments for Alzheimer Disease: The Role of Primary Care in Managing the Patient Journey
Jenny Lam, Jakub Hlávka, Soeren Mattke
The Journal of the American Board of Family Medicine Nov 2019, 32 (6) 931-940; DOI: 10.3122/jabfm.2019.06.180328

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The Potential Emergence of Disease-Modifying Treatments for Alzheimer Disease: The Role of Primary Care in Managing the Patient Journey
Jenny Lam, Jakub Hlávka, Soeren Mattke
The Journal of the American Board of Family Medicine Nov 2019, 32 (6) 931-940; DOI: 10.3122/jabfm.2019.06.180328
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Keywords

  • Alzheimer Disease
  • Amyloid Beta-Peptides
  • Biomarkers
  • Cognitive Dysfunction
  • Dementia
  • Diagnostic Tests
  • Disease Progression
  • Mental Status and Dementia Tests
  • Primary Health Care
  • Sensitivity and Specificity

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