Alzheimer Diagnosis in older Adults with Chronic Conditions ADACC Network

PROJECT SUMMARY / ABSTRACT Approximately 60% of older adults with Alzheimer’s disease or a related dementia (ADRD) have three or more chronic conditions. Multiple chronic conditions (MCCs) and frailty are also risk factors for ADRD and can affect the expression of AD pathology with regards to cognitive function, disease stage, and neuropathological burden. Utilizing biomarkers to diagnosis ADRD may provide a more accurate and cost-effective assessment of the underlying etiology contributing to the cognitive impairment and may guide treatments and counseling about individualized care pathways. However, widespread incorporation of these biomarkers into routine clinical care and population screening programs for older adults with multiple MCCs and cognitive impairment has not occurred. Blood-based biomarkers are now clinically available to aid in the diagnosis of ADRD and are more feasible, especially for older adults with MCCs, and less costly and invasive than CSF or PET-based biomarkers. However, no research has examined these blood biomarkers for the diagnosis and prognosis of ADRD in primary care, especially among diverse populations. It is unknown how and when these blood biomarkers should be used, particularly for diagnosis and prognosis among older adults with MCCs and/or limited life expectancy. Moreover, the effect of MCCs on levels of the biomarkers are not well understood. Numerous other questions remain, such as: 1) whether the ADRD biomarkers enhance prognosis among older adults with MCCs and cognitive impairment; 2) for whom it is most beneficial to obtain ADRD biomarkers including blood, CSF or imaging; 3) how the biomarkers can be implemented in a primary clinical healthcare delivery model; 4) whether there are subgroup differences (e.g. race/ethnicity, sex, MCCs) that affect the interpretation of the biomarkers; 5) assessment of cost estimates and risk/benefit ratios for reimbursement; 6) how best to communicate the results to patients and their caregivers; and 7) the ethical aspects of biomarker collection and potential for incidental findings due to mixed pathologies, especially among older adults. The overall goal of this application is to establish a national consortium, the Alzheimer’s Diagnosis in older Adults with Chronic Conditions (ADACC) Network, consisting of multi-disciplinary investigators that will address these and other questions, and develop evidence-backed strategies and guidelines for the use and implementation of biomarkers for ADRD diagnosis in older patients with MCCs and cognitive impairment. The consortium will have an Executive Committee, Steering Committee, and Data Coordinating Center. It will fund three pilot projects each year and convene an annual meeting. Working groups will be developed to focus on the questions listed above and others. Successful completion of the grant aims will advance the diagnosis and care of older adults with MCCs and cognitive impairment by increasing understanding of how and when to implement ADRD biomarkers.