Interceptor Project: On Early Diagnosis Of The Prodromal Stage Of Alzheimer Disease. The Progression From Mild Cognitive Impairment (Mci) To Dementia: The Role Of Biomarkers In Early Interception Of Patients Candidate For Prescription Of Future Disease-Modifying Drugs

In the next 8 years a number of phase 2-3 trials will end up which utilize experimental drugs possibly disease modifying for Alzheimer Dementia. They target different disease stages: mild-moderate AD, 'early' AD, MCI prodromic to AD (MCI + for biomarkers heralding progression to AD), pre-symptomatic AD in pathogenetic gene mutation carriers of familiar AD forms. This dense clinical trials activity has triggered a fundamental question both from Patients and Scientific Communities and Health Authorities/Insurances: on which basis will the new drugs -if effective-be distributed to patients or at-risk population? This question mainly deals with the "MCI prodromal to AD"condition since the MCI population actually includes about 50% of those who will progress to AD (the real "prodromic to AD" MCI form) while the remaining 50% will never convert to AD. Since the new drugs -if effective- will carry both elevated unit costs and not marginal side-effects, they should be administered selectively to those MCI with a severely high risk of conversion (i.e. 90% or more) and particularly to those with a highrisk of rapid conversion (1-2 years from diagnosis of the MCI condition).

The INTERCEPTOR project is focused on the prodromic AD condition (IWG2) or the MCI condition (NIA-AA) which form the neuropsychological point of view and is characterized by means of: cognitive questionnaire, screening test (MMSE), extended neuropsychological evaluation (incl. 2 episodic memory tests, language test, visuo-spatial abilities evaluation, behavioural scales, functional scales (Annex), full neurological examination. CDR must be 0.5. Atypical types of clinical presentations must be particularly considered (i.e. non amnesic debut) for a differential diagnosis where the role of biomarkers is pivotal.

In Italy, according to a recent study, an MCI prevalence of 5.9% has been evaluated in over 60 yrs population, with an increase of 4.5% between 60 & 69 yrs, of 5.8% between 70 & 79 yrs, and up to 7.1% in the 80 - 89 yrs range. On this epidemiological basis about 735.000 MCI cases are estimated for 2016in the resident Italian population. Multicentric non therapeutic cohort study in subjects fulfilling the MCI "core" criteria as defined by the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. The study design reflect a longitudinal cohort study in which the baseline clinical and biomarkers characteristics of the enrolled MCI subjects at baseline will be compared for those classified as "AD converters" after 3.0 years of follow-up with respect to those "non-converters". MCI subjects who will convert to other forms of dementia will be examined separately.

All the medications at baseline are allowed without modifications for the whole protocol except for urgencies.

Neuropsychological follow-up tests will be carried out at 6 months intervals (total 7 from T0= baseline to T6= 42 months).