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Alzheimer’s disease (AD) is the most common neurodegenerative disease. Biomarkers have demonstrated that AD pathology exists over the disease continuum from a stage preceding symptoms over 15-25 years to the progressively more impaired symptomatic states, mild cognitive impairment (MCI), and dementia. Biomarkers include: amyloid (Aß), phosphorylated tau, and neurodegeneration. The plasma assays for Aß and tau show great promise for clinical and research use. This review has aimed not only to present the ATN diagnostic classification and the preclinical AD concepts in addressing some possibilities of cognitive assessment instruments, but also to briefly summarize the main anti-amyloid monoclonal antibodies studied in clinical trials. In addition, this paper presents a critical analysis by experts in cognitive neurology while addressing the question as to whether we are prepared for the anti-amyloid therapy era or not. RESUMO A doença de Alzheimer (DA) é a doença neurodegenerativa mais comum. Os biomarcadores demonstraram que a patologia da DA existe ao longo do continuum da doença, desde um estágio anterior à sintomatologia, ao longo de 15 a 25 anos, até os estados sintomáticos progressivamente mais prejudicados, comprometimento cognitivo leve (CCL) e demência. Eles subdividem-se em três categorias: amiloide (Aß), tau fosforilada e neurodegeneração. A dosagem de Aß e tau plasmáticos mostra uma grande promessa para uso clínico e de pesquisa. Esta revisão teve como objetivo apresentar a classificação diagnóstica da ATN, os conceitos pré-clínicos da DA e abordar algumas possibilidades de instrumentos de avaliação cognitiva, mas principalmente resumir brevemente os principais anticorpos monoclonais anti-amiloide estudados em ensaios clínicos. Além disso, este artigo apresenta uma análise crítica de especialistas em neurologia cognitiva: estamos ou não preparados para a era da terapia anti-amiloide?

Background: Some older adults with subjective decline (SCD) had a positive amyloid biomarker indicating a preclinical stage of Alzheimer’s disease. Objectives: To assess the accuracy of Delayed Recall of Figure Memory Test (DR-FMT) of Brief Cognitive Screening Battery to predict amyloid status in SCD older adults. Objective: To assess the accuracy of Delayed Recall of Figure Memory Test (DR-FMT) of Brief Cognitive Screening Battery to predict amyloid status in SCD older adults. Methods: The sample consisted of 45 older adults classified as SCD and 25 as controls without complaints (mean age of 76.4 and 73.5, respectively, p= 0.138). They were evaluated with BCSB and a standard neuropsychological battery (which includes MMSE, MoCA, RAVLT, Logical Memory and DR of Rey Complex Figure). Subjects underwent PIB-PET to assess their amyloid status and images were classified based on visual and semi-quantitative analyses with 3DSSP methodology. Results: Twelve SCD older adults (27.3%) had positive PIB-PET against six in the controls (23.1%). In SCD group, DR-FMT was the only memory test that correlated with SUV in amyloid PET (r = -0.514, p < 0.001). Only DR-FMT showed significant area under the curve (AUC) in the ROC curve in SCD older adults (AUC = 0.771, 95% CI 0.621 - 0.921). Among SCD older adults, DR-FMT < 8.0 had a sensitivity of 83.3%, a specificity of 68.7% and an accuracy of 72.7%. Conclusion: FMT proved to have a good sensitivity and accuracy to predict amyloid status in SCD older adults.