Clinical trials  will ultimately tell us what prevents or delays Alzheimer’s and cognitive decline. But other areas of research are critical for developing successful prevention strategies. Basic studies of the cellular and molecular roots of Alzheimer’s are revealing a wide range of processes that interfere with, or enhance, the function and survival of nerve cells in the brain. These basic research discoveries  point to new targets for Alzheimer’s treatment.
Translational studies  build on the findings from basic research to develop new drugs and interventions. More than 60 projects in the NIA’s translational research portfolio have supported early drug discovery and early clinical development of new treatment compounds for Alzheimer’s. The goal is to expand possible avenues for Alzheimer’s prevention and treatment and, eventually, to increase the number of therapies that can be tested in humans.
Finding Out Who Is At Risk
Several clinical trials of medications  and other therapies have failed to improve memory and other thinking skills in people diagnosed with Alzheimer’s disease. Scientists want to try some of these interventions earlier in the disease process, in cognitively normal people at high risk of developing Alzheimer’s, to see if they can prevent or delay the onset of the disease.
To conduct such studies, researchers must first figure out which people without Alzheimer’s symptoms are in fact at risk of developing the disease. Because the brain damage caused by Alzheimer’s  begins years before memory loss and other symptoms may appear, scientists are developing methods to detect biological changes related to Alzheimer’s disease at its earliest stages.
Researchers are finding that changes in certain proteins in blood and cerebrospinal fluid and results of brain scans can indicate early Alzheimer’s-like changes in the brain. Understanding more about these biomarkers  may reveal how Alzheimer’s disease begins and develops. Biomarkers also may help scientists track whether certain medications have their intended effects early in the course of the disease.
An NIA-led public-private partnership—the Alzheimer’s Disease Neuroimaging Initiative  (ADNI)—is examining the relationship between these biomarkers and cognitive changes in older participants who are cognitively normal or have MCI or Alzheimer’s. Scientists hope the results will help identify ways to determine the risk of Alzheimer’s disease  more accurately in people without dementia symptoms.