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 ADACC NETWORK

Alzheimer's Diagnosis in older Adults with Chronic Conditions (ADACC) Network

MISSION

The ADACC Network is an inclusive group of multidisciplinary stakeholders focused on developing evidence-based strategies for the use and implementation of ADRD biomarkers among older adults with cognitive impairment and multiple chronic conditions at the population level

Background

Approximately 60% of older adults with cognitive impairment or Alzheimer’s disease and related dementias (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.

It has been estimated that 50-70% of symptomatic patients with ADRD are not recognized or are incorrectly diagnosed in primary care. There is a limited capacity of ADRD specialists and limited availability of resources for PET scanning and lumbar punctures at the population level. The emergence of blood-based biomarkers may enhance ADRD clinical diagnosis for older adults with cognitive impairment and MCCs in real-world clinical settings.  However, there are crucial gaps in knowledge regarding the feasibility, acceptability, accuracy, implementation, and cost reimbursement of ADRD blood and other biomarkers in real world clinical populations with MCCs.  For example, comorbidities such as kidney disease, obesity, and cardiac conditions and medications may impact levels of the AD blood biomarkers and result in false positive and false negative results.  In addition, there are many ethical aspects that warrant consideration prior to widespread implementation.

The patient journey for older adults with MCC’s and cognitive conditions is difficult with regards to diagnosis, prognosis, and treatment and it is complicated by consideration of patient preferences. ADRD biomarkers have the potential to enhance the care of these patients. However, numerous questions remain and the utility of the biomarkers in primary care is unknown. 

 

The Alzheimer’s Diagnosis on older Adults with Chronic Conditions (ADACC) Network is a National Institutes of Health funded program (Grant #: U24 AG082930) in collaboration with the National Institute on Aging to advance understanding of the use and implementation of biomarkers for the diagnosis of ADRD among older adults with MCCs.  It brings together key stakeholders from multiple disciplines, as well as patients and families. It consists of the collaboration of several existing diverse observational and real-world cohorts, the award of annual pilot projects, the development of several working groups to address specific questions, and the development of an annual conference to enhance discussion and to develop best-practice guidelines.

Specific Aims

1

Establish a Data Coordinating Center to identify and assemble existing ADRD observational and real-world cohorts representative of older adults living with MCCs.

2

Convene and organize Work Groups that will examine the performance and accuracy of the blood biomarkers in older adults with MCCs. Topics will include:

3

Convene experts and organize Work Groups to develop recommendations for how blood biomarkers should be used in primary care for ADRD diagnosis/prognosis in older adults with MCCs.

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