CHICAGO--The quest for a clear way forward in neurodegenerative imaging and therapeutics continues, with many of the same challenges continuing from previous years, according to a neuroimaging symposium during the Radiological Society of North America’s (RSNA) 99th annual meeting.

Amyloid imaging is limited for disease progression studies because it is present in healthy brains—as much as 25 percent of cognitively healthy patients reveal some amyloid accumulation. Amyloid levels also peak and then plateau in patients with Alzheimer’s disease, which means amyloid imaging stops producing useful longitudinal data.

“Amyloid is not ideal for disease progression,” said Alexander E. Drzezga, MD, from Harvard University Medical School in Boston, during the session.

To complicate diagnostic use, amyloid is also present in other neurodegenerative diseases, including dementia with Lewy bodies. Amyloid imaging would not be indicated for use in asymptomatic patients with neurodegenerative disease.

Also challenging is the fact that anti-amyloid drug studies have not provided any encouragement.

“The view of anti-amyloid drugs is disappointing so far,” added Drzezga. This is due to the fact that anti-amyloid drug therapy has led to incomplete or lackluster relief in symptoms, even after substantial stripping of amyloid has been achieved.

Drzezga points to a united front of neurodegenerative imaging and therapeutics for the future that will have to combine or play upon multiple channels of pathology for diseases like Alzheimer’s and Parkinson’s, including but not limited to specialized TDP-43, a-synuclein and tau protein imaging.