The biggest issue, and many of us agree on this, is the APOE genotype. Alzheimer’s disease really needs to be broken down according to genotype. The information from genotype, combined with age, provides more information about stage of the disease that the brain scans or the CSF beta-amyloid measures. CSF-tau levels tell more about the levels of impairment, but there remains no understanding of how the beta-amyloid factors relate to the tau (neurofibril) factors.
For now, I think we need to focus on improving our ability to measure memory. I don’t think that CSF values or fancier brain scans or more complex brain scan analyses are going to be useful at the individual clinical practitioner level yet. My argument in my talk was that we need to keep the costs down and the basic support up until we can develop real benefits for early diagnosis, which means preventive interventions.