The challenging aim of present project is to develop a novel approach to cognitive evaluation, for identifying minor (miND) and major (MaND) neurocognitive disorders in their very early stage, well before individuals' performance becomes defective or individuals become aware that their performance has worsened. Indeed, battery of tests available to date pay attention to differentiate normal from pathological performances, but can not detect anomalous changes in normal abilities. In present study we will use tests developed for accurately detecting individual differences in performances due to aging, with the aim to provide an instrument sensitive to the subtle changes in normal performance that signal the onset of a neurodegenerative pathology. Indeed, onset of cognitive deficits in MaND (i.e., Alzheimer, FTD,etc.) is subtle and progressive (with underlying brain pathology starting even 15yrs before first clinical signs.
Thus, individuals who will develop a MaND will show a progressive decline of cognitive skills, characterized by a worsening of performances greater than that expected in normal aging,that can precede by years the onset of deficit. Evaluating the rate of decline in cognitive skills known to be involved in the early stages of MaND will allow to detect the presence of brain pathologies in their pre-clinical stages, well before the onset of miND/MaND. Due to individual differences in performances by healthy individuals, detecting abnormal rates of decline may be difficult. For this reason our battery consists in a "monitoring system of individual performances (MoSIP)", allowing to detect anomalous aging by comparing consecutive sessions of evaluation in the same individual at given time intervals (6 months). Comparing an individual performances in consecutive sessions will let to compute his/her slope of cognitive aging that will be compared with the expected one. A slope deeper than expected will signal the presence of a brain pathology.
Results of present project will provide an advancement in the knowledge of the pre-clinical and early stages of pathological aging as well as a novel way to monitor aging in healthy population.
The parallel batteries of tests we will develop (MoSIP), by evaluating the rate of aging of different cognitive functions, will allow to detect very early signs of anomalous aging even in healthy individuals who do not yet complain any difficulty in daily life. The opportunity to identify signs of anomalous aging in healthy individuals whose cognitive abilities are still well within the normal range and who are still living an active, autonomous life, will have important scientific, social and economic impact.
Indeed, from a scientific point of view it will represent a great opportunity to study the progression of miND and MaND pathologies in selected population of (at-the-moment) healthy individuals predicting with a high level of confidence who is going to develop cognitive decline and who is not. The possibility to classify individuals according to the presence/absence of anomalous, but yet normal, aging together with the possibility to utilize the parallel version of MoSIB would result in an important opportunity for developing future multi-centric studies aimed on one side to further understanding the physio-pathological mechanisms underlining these pathology, and
on the other side to develop and test the efficacy and effectiveness of novel pharmacological and behavioral therapies that would effectively fight the onset of neurodegenerative disorders.
An added value surely provided by MoSIB database, that will allow: 1. access data for retrospective studies; 2. select individuals to be recruited for novel studies, 3. access to updated cut-offs and an automized monitoring
of individual performances.
From a socio-economical point of view, the identification and the successive monitoring of ongoing onset in still fully healthy individuals may contribute to enhance the prevention of the loss of autonomy and to increase the
number of elder individuals who are able of social active participation. The preclinical identification of the future and ongoing onset of neurodegenerative disorders will also allow to better plan the future needs of health care and social assistance services, permitting to avoid errors in the deployment of resource. Furthermore, the possibility to prevent mental decay and loss of autonomy by setting up treatments in very early, preclinical stages will
correspond to significant reductions of the social cost for the assistance in healthy services and of the economical, healthy and social burdens of caregivers and families.