Cognitive biomarkers for detecting dementia and possibilities for cognitive enhancement

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• Professor Barbara Sahakian, FMedSci, Department of Psychiatry and Behavioural and Clinical Neurosciences Institute, Cambridge
• Tuesday 29 September 2009, 12:30-13:00
• West Road Concert Hall.

If you have a question about this talk, please contact Hannah Critchlow.

This talk is part of the Cambridge Clinical Neuroscience and Mental Health Symposium, 29th – 30th September 2009 at West Road Concert Hall. This event is free to attend for cambridge neuroscientists although registration is required. To register, and for further information, please visit: http://www.neuroscience.cam.ac.uk/cnmhs/

Abstract: Biomarkers represent an important development for the early detection of neuropsychiatric disorders, such as Alzheimer’s disease (AD) and schizophrenia. Uses of biomarkers include:

• To identify high risk groups in the population,

• To improve diagnosis and early detection of disorders,

• To predict treatment outcomes,

• To predict harms caused by side effects of drugs,

• To assist in drug discovery.

The incidence of dementia increases with age and, with the ageing population in the UK, the number of people with dementia could double over the next 30 years to 1.4 million. This would bring the costs to the UK economy from £17 billion per year to over £50 billion per year. There are currently a number of drugs in development which are aimed at enhancing cognition in mild to moderate AD or in halting the disease progression. Treatment with these latter agents must begin before the damage is done in AD, that is prior to severe brain damage and dementia, with the consequent marked impairments in activities of daily living and quality of life. Individuals need to be identified earlier on in the natural history of AD if they are to benefit from such an intervention. It is also unlikely that any pharmacological intervention will work optimally in a brain with severe pathology of Aß plaques and neurofibrillary tau tangles. Furthermore, it is likely that first generation neuroprotective agents may have considerable side-effects and therefore it is important to know which individuals are likely to benefit so that accurate risk-benefit analyses can be made. Useful biomarkers in neuropsychiatry might include novel proteome-based CSF , blood and plasma measures, neuroimaging markers or measures of cognition obtained from objective, computerised test batteries such as the CANTAB (Cambridge Neuropsychological Test Automated Battery). Results from the CANTAB Paired Associates Learning (PAL) Test have proved encouraging as a cognitive biomarker in detecting those individuals with mild cognitive impairment (MCI) who will progress to a diagnosis of AD. Impairment on another task from this battery, Spatial Working Memory (SWM), is associated with later onset of psychosis in individuals known to be at high genetic risk for this disorder. In conclusion, disorders of cognition may sometimes be best detected with cognitive biomarkers, which are non-invasive and easy to implement. In addition, they can be used effectively with other biomarkers, such as genetic and neuroimaging ones.

Biography: Barbara J Sahakian is Professor of Clinical Neuropsychology at the Department of Psychiatry, University of Cambridge School of Clinical Medicine and Honorary Consultant Clinic Psychologist at Addenbrooke’s Hospital. She has an international reputation in the fields of cognitive psychopharmacology, neuroethics, neuropsychology, neuropsychiatry and neuroimaging. She is co-inventor of the CANTAB computerised neuropsychological tests, which are in use world-wide. She is probably best known for her research work on cognition and depression, cognitive enhancement using pharmacological treatments, neuroethics and early detection of Alzheimer’s disease. Indeed, she has over 300 publications covering these topics in scientific journals, including Science, Nature, Nature Neuroscience, The Lancet, British Medical Journal, Archives of General Psychiatry, American Journal of Psychiatry, Biological Psychiatry, the Journal of Neuroscience, Brain, Psychopharmacology and Psychological Medicine. Her current programme of research, funded by the Wellcome Trust and Medical Research Council, investigates the neurochemical modulation of impulsive and compulsive behaviour in neuropsychiatric disorders, such as unipolar and bipolar depression and attention deficit hyperactivity disorder. This topic was the focus of her recent papers published in Science, (Chamberlain et al 2006, Chamberlain et al 2008). Professor Sahakian was one of the first researchers to suggest that attentional dysfunction in Alzheimer’s disease could be ameliorated using pharmacotherapy, such as cholinesterase inhibitors. In addition, she was early to highlight the cognitive changes in unipolar and bipolar depression, as well as their significance for functional outcome. In 2003, she was selected to lecture on this topic for the Teaching Day at the annual meeting of the American College of Neuropsychopharmacology (ACNP). Most recently, she has introduced the importance of the concept of cognitive reserve to the field of neuropsychiatry (Psychological Medicine, 2006, 36, 1053-1064).

This talk is part of the Clinical Neuroscience and Mental Health Symposium series.

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