Modem: comprehensive modelling of costs and outcomes of interventions with dementia

Development of therapies for neurodegenerative diseases depends on advances in understanding the basic mechanisms of the disease. These advances are usually dependent on new technologies that advance either diagnosis or the ability to pursue basic research. For Alzheimer’s Disease (AD) the emergence of the irst therapies have very much followed this path. Discovery of the cholinergic deicits in AD followed the publication of a new and sensitive assay for acetylcholine synthesis, and this led to the acetylcholinesterase inhibitors that are now the main therapies available. As abnormalities of glutamate metabolism were determined, the one currently approved glutamate receptor modulator memantine emerged, the last approved medication for AD in over a decade. All are directed at boosting or regulation of neurotransmitter metabolism. As the identity of the primary proteins in neuritic plaques (NP) and neuroibrillary tangles (NFT) were determined and other neuropathological cascades identiied, new therapeutic strategies and medications have evolved in the therapeutic pipeline. These are denoted as “disease-modifying” since they affect the structural changes brought about by the degeneration. Thus two general designs of strategies of treatment are emerging. Treatments for people with MCI and AD can use biomarkers to conirm the disease and allow symptomatic studies to proceed eficiently. Biomarkers revealing the presence of disease in cognitively normal people allow initiation of studies of preclinical disease, which would enable the long sought goal of disease prevention or delay of emergence.