Artist's rendering of a brain cell damaged by amyloid beta plaque in Alzheimer's disease

People who changed cognitive status from impaired to normal during clinical trials tend to be younger, have better cognition and be negative for amyloid biomarkers, according to a new study.

Researchers published a report in Alzheimer’s & Dementia on Monday. They looked at whether reverters — people who go from a Clinical Dementia Rating® score of 0.5 to 0 — differed on cognition and biomarkers compared to people without impairments (who always had a 0 score). 

Knowing about the presence and severity of dementia is imperative for studies that explore aging and dementia. The Clinical Dementia Rating® is used to evaluate cognitive status in large cohorts that are used for research about the disease. 

Clinical trials investigating therapies to stop or slow the progression of dementia look at older adults who are most likely to experience a change in cognitive status (as in, those who are cognitively normal without symptoms or people with mild to moderate symptoms). Understanding clinical reversion (a pattern of moving back and forth between a clinical classification of cognitively normal and cognitively impaired) could help better predict who will experience change and affect who’s eligible for research. 

Studies on clinical reversion have found that going from impaired to normal cognitively is common. Knowing more about who could potentially revert, and who may not, can help researchers target who to study and/or anticipate the results of a therapy.

The team looked at the apolipoprotein E (APOE) ε4 gene, as well as cognition. 

Those who reverted to normal and eventually went back to impaired were older — that happened to 46% of people studied. They also were more likely to have APOE ε4 alleles (variations of these genes) and had more visits to assess their Clinical Dementia Rating® score. 

Reverters had more cognitive decline over time than those who stayed in the cognitively normal category.

The authors wrote that the results of the study indicate that people who revert from impaired cognitive ability back to normal may be good candidates for secondary prevention trials.