Bibliographic record
Abstract
Can J Psychiatry. 2011;56(10):577-578. Many thanks to the editor-in-chief for this timely opportunity to provide the readers of The Canadian Journal of Psychiatry (The CJP) with an update on the fast-moving field of Alzheimer disease (AD). As detailed in the reviews by Dr Fadi Massoud and Dr Gabriel C Leger1 and by Dr Clive Ballard and colleagues2 in this issue of The CJP, the current symptomatic drugs are only 1 0 years old, cognitive training is still under development, and disease-modifying drugs are under study. This past spring alone you will have seen the publication, in Alzheimer 's & Dementia: the Journal of the Alzheimer 's Association, of revised diagnostic criteria for AD probable at the traditional dementia stage,3 for AD at the predementia stage,4 and even for AD in the presymptomatic stage,5 in Brain, of cognitive training-related plasticity in people with mild cognitive impairment,6 and in The Lancet, of a seminar on the epidemiology and pathophysiology of AD.7 How is Canada doing in the field of AD? The Canadian Study on Health and Aging8 gave us a good head start, with incidence and prevalence figures across the country for the late 1980s against which we will compare later this decade. When Cholinesterase inhibitors (ChEIs) first became available, family doctors were allowed to prescribe these medications and they are following evidence-based guidelines for diagnosis and treatment common to all interested physicians, the latest revision being done in 20069 and the next one scheduled for 2012. A network of specialized memory clinics was created in the early 1990s to facilitate randomized clinical trials for AD in Canada: the Consortium of Canadian Centres for Clinical Cognitive Research (commonly referred to as C5R). This network is 1 of 5, worldwide, currently planning for global prevention studies.10 More recently, the Canadian Institutes of Health Research initiated the International Collaborative Research Strategy for Alzheimer's Disease (commonly referred to as ICRSAD), including partnership with the United States in the Alzheimer Disease Neuro-Imaging (commonly referred to as ADNI) program, with Germany, the United Kingdom, and other European countries in biomarkers and other technical platforms, and with China for 5-year studies. The Alzheimer Society of Canada has been a strong supporter of AD research in Canada, particularly in training young people from different disciplines. The less positive side of treatment of AD in Canada has been the difficulty in obtaining reimbursement for AD medications across the country. The rivastigmine patch is reimbursed only in 1 province, despite the evidence for better tolerability than the oral formulation, which allows 1 0 mg (current maximal dose), compared with 1 5 mg dosing, in a randomized study about to be concluded. Memantine is reimbursed in only 2 provinces, despite the evidence for benefit on agitation and speech impairment, and even in that 1 province memantine is reimbursed only as monotherapy; for example, not with a ChEI, despite growing evidence for the value of combining the 2 drug classes.1112 In the United States and France, these 2 classes of drugs are routinely combined in the moderate stage of AD. There are even greater challenges ahead: if and when treatments become available to significantly slow down disease progression, how will we convince payers to reimburse them? We need to do a better job of finding responders to treatment during phases II and III of drug development: age at onset of symptoms and severity of symptoms may modify which drug to use, apoE genotype and possibly other genes - the pharmacogenomics of AD.13 Clear start and stopping rules will have to be established. It is conceivable that reimbursement will be conditional on positive biomarkers, such as amyloid deposition measured by positron emission tomography scanning or abnormal beta-amyloid and tau protein levels in cerebrospinal fluid. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.006 | 0.010 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.007 | 0.009 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".