Neurology Central

Paradigm shift: semantic memory decline as a biomarker of preclinical Alzheimer’s disease

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Uncovering the presence of Alzheimer’s disease (AD) in routine neurological management of middle-aged/elderly adults, and differentiating its combination of symptoms from those induced by the processes of normal aging, neurovascular disease or psychiatric conditions (e.g., depression), are challenges of primary importance. Usually, it is the onset of behavioral symptoms that encourages patients with AD and caregivers to seek medical attention for the first time. Research evidence, however, shows that the earliest changes triggered by the disease on the biology of the brain occur several decades prior to any behavioral change of clinical relevance [1]. Based on this large preclinical-stage/symptomatic-stage temporal discrepancy, it is of paramount importance to identify biomarkers that are more effective than those currently used in clinical practice. An ideal biomarker should be of as early diagnostic help as possible in the disease-progression timeline, as well as highly sensitive and specific. On this note, the use of cognitive tests is among the most proficient sources of clinical information in the early phases of AD, due to their validity, reliability and simplicity/immediateness. A skillful interpretation of neuropsychological performance may offer an indirect, yet fruitful view of the pathological processes affecting the nervous system, which could be the result of incipient AD.

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