In five to ten years, pharmaceutical companies will likely be on the threshold of delivering drugs or other treatments that can slow down or stop Alzheimer’s disease before it starts. Who should be treated with these hypothetical compounds? Everyone? That would be prohibitively expensive, and even dangerous if—as most drugs do—the new treatments are accompanied by side effects. The most effective way to use the new therapies would be to give them only to those people likely to develop Alzheimer’s disease. The sticking point is that Alzheimer’s disease is usually not diagnosed until patients are so severely impaired that treatments that delay the disease would be useless.

That’s where Liana Apostolova, MD, Assistant Professor of Neurology at UCLA, comes in. Like many Alzheimer’s researchers, Dr. Apostolova is working to devise an effective way to identify who will get Alzheimer’s disease years before any definitive symptoms develop—in other words, she is searching for a reliable biomarker for Alzheimer’s disease. Her tool of choice is magnetic resonance imaging (MRI). Recent technological improvements in the quality of brain scans as well as in the software used to process data now allow Dr. Apostolova and her colleagues to create highly detailed, three-dimensional maps of patients’ brains. “We want to diagnose Alzheimer’s disease earlier, using a non-invasive, sensitive tool,” says Dr. Apostolova. “We need to be able to accurately identify Alzheimer’s disease in people who haven’t yet declined.”

The National Institute on Aging and several private foundations, including the American Federation for Aging Research, recognized the importance of Dr. Apostolova’s work in 2005 when they awarded her a Paul Beeson Career Development Award in Aging Research. A generous, three-to-five year grant of $600,000 to $800,000, the award gives recipients the funding, time, and support they need to concentrate on their investigations and ground a successful career in aging research.

Dr. Apostolova didn’t take long to put her Beeson funding to good use. Her work first drew media attention in May 2006, when she published a study in Archives of Neurology. The work showed that among patients diagnosed with mild cognitive impairment (MCI)—a state of mild memory impairment that often, but not always, converts to Alzheimer’s disease—those with greater atrophy in certain regions of the hippocampus were more likely than those with a larger hippocampus to progress to Alzheimer’s disease within three years. The hippocampus is a small, complex region of the brain critical to memory formation.

Six months later, Dr. Apostolova expanded upon her work in the November 2006 issue of Brain. In this study, Dr. Apostolova refined her mapping of hippocampal atrophy in Alzheimer’s disease, testing a hypothesis that Alzheimer’s subjects have greater atrophy in specific hippocampal subregions than patients with MCI. They found that the volume of the hippocampus was a significant predictor of whether a patient was diagnosed with MCI or Alzheimer’s, and found that as Alzheimer’s develops, hippocampal atrophy spreads in a predictable pattern.

More recently, in the October 2007 issue of Archives of Neurology, Dr. Apostolova and her colleagues at UCLA expanded their investigations to the cortex. Comparing MRI scans of 24 MCI patients to those of 25 patients with mild Alzheimer’s, they found that patients with Alzheimer’s disease exhibit significantly more atrophy in certain subregions of the cortex than those with MCI. Unsurprisingly, cortical areas known to be affected early in Alzheimer’s disease were more impaired than those affected late in the disease. Mapping the progress of Alzheimer’s disease through the brain could be invaluable as pharmaceutical companies move potential Alzheimer’s disease therapies into clinical trials, allowing them to gauge the effectiveness of disease-slowing treatments. “Previously, we could see these changes in the brain only post-mortem, in an autopsy,” notes Dr. Apostolova. “Now we can view them in vivo, in live patients.”