Many genetic and biological abnormalities are associated with AD. The challege is to choose the markers which alone or in combination best predict the development of AD, or which best indicate the presence of AD at the earliest possible stage. The authors' conception of pathogenesis of AD is given in Figure 1. Figure 2 depicts the bidirectional interactions thought to occur between the neuroendocrine and immune systems during the acute phase response. Tables 2-10 summarize peripheral biological markers that have been reported to be associated with AD since 1993. Sensitivities and specificities have been provided in the present chapter only for markers that have been well-researched and confirmed. Studies carried out before 1993 are summarized in Ref. 294. The reader also is referred to other reviews of peripheral markers of Alzheimer disease that have appeared recently (15,18,25,26,76, 102,106,109,118,120,123a,139,149,185,190202,221241,244,321,398).

In this section we describe some peripheral biomarkers presently under investigation, and discuss their potential for the earlier detection of AD and their relation to the Alzheimer pathogenic pathway.

Fig. 1. Possible interactions between degenerating brain and peripheral tissues in Alzheimer disease. IL, interleukin; a-1 ACT, a-1 antichymotrypsin; t, tau.
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