Alzheimer’s disease diagnosis, biomarkers, white matter hyperintensities, and other things that keep Adam Brickman, PhD up at night
An Institute on Aging Visiting Scholar Series and Penn Neurodegenerative Disease Grand Rounds lecture recap
Can vascular changes in the brain contribute to Alzheimer’s disease risk and progression? This is the subject that drives most of the research of Adam Brickman, PhD, Professor of Neuropsychology, Columbia University.
During his recent lecture at the University of Pennsylvania, Dr. Brickman discussed why he believes Alzheimer’s should be understood as more than a single pathology. While amyloid has traditionally been a major focus of Alzheimer’s research, Brickman points to evidence that other changes—including vascular and inflammatory processes—may also contribute to the symptoms and progression of the disease.
One area of his research focuses on white matter hyperintensities – bright white spots seen on an MRI scan showing changes in the brain. While these changes can be a normal part of aging and are often common among older adults, they may also reflect more significant vascular or inflammatory processes that may point to biology that is related to Alzheimer's disease and other degenerative conditions. In their work, Dr. Brickman and his colleagues were surprised to find that people with genetic forms of Alzheimer’s can show these vascular changes even without traditional risk factors such as hypertension, diabetes, or smoking. Replicating that finding has led his team to investigate whether there may be an intrinsic vascular component to Alzheimer’s disease.
One important shift in the field that is helping researchers to explore these questions in new ways is the growing availability of blood-based biomarkers. These biomarkers can be a vital tool for understanding why some people develop cognitive impairment while others do not—and may ultimately lead to a more complete picture of the disease.
“It's an important distinction whether someone has the biological changes of Alzheimer's disease and whether they have the biological changes of Alzheimer's disease with clinical symptoms,” explained Dr. Brickman. “So, we can use biomarkers to understand if there are changes in the brain, and that might put someone at risk for developing cognitive changes down the road. You can have those biological changes in the brain without having any symptoms, or you can have symptoms without some of the biological changes related to Alzheimer's disease.”