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Neurodegenerative disorders such as Alzheimer's disease (AD) are increasingly recognised to have a long prodromal stage before the onset of symptoms defining the dementia syndrome. This phase may last up to years or even decades. An intensive search has been initiated for signs or symptoms that might enable prediction of dementia development.1 The motivation for identifying such predictors comes from the assumption that disease-modifying treatment might be more effective in early or even presymptomatic stages when the pathogenic mechanisms have not progressed, and irreversible damage to neurons and neural networks is still limited. Therefore, early recognition of imminent dementia may play an important role in the future.
In addition, a definition of dementia that focuses on cognitive symptoms might conceal early non-cognitive symptoms. In fact, we have learned from diverse recent studies that dementia is often preceded by depressive symptoms years before the onset of cognitive decline. It remains unclear, however, whether depression actually represents an early disease symptom, a psychological reaction to cognitive deterioration perceived by the affected individual, or whether it is a true risk factor for dementia …
Contributors Original draft and bibliography by TG and MH: both authors have contributed equally to the elaboration of this text.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.