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        Could a simple urine test detect early stage Alzheimer’s disease, paving the way for mass screening programs? The new Frontiers in Aging Neuroscience study certainly shows this. The researchers tested a large group of Alzheimer’s patients of varying severity and healthy individuals who were cognitively normal to identify differences in urine biomarkers.
        They found that formic acid in the urine is a sensitive marker of subjective cognitive decline and may herald the early stages of Alzheimer’s disease. Existing methods for diagnosing Alzheimer’s disease are expensive, inconvenient, and not amenable to routine screening. This means that most patients are only diagnosed when it is too late for effective treatment. However, a non-invasive, inexpensive, and convenient urinalysis for formic acid may be exactly what doctors are asking for for early screening.
        “Alzheimer’s disease is a persistent and insidious chronic disease, meaning it can develop and persist for many years before overt cognitive impairment appears,” the authors say. “The early stages of the disease occur before the stage of irreversible dementia, which is a golden window for intervention and treatment. Therefore, large-scale screening for early-stage Alzheimer’s disease in the elderly is warranted.”
        So, if early intervention is important, why don’t we have routine screening programs for early stage Alzheimer’s disease? The problem lies in the diagnostic methods doctors currently use. These include positron emission tomography of the brain, which is expensive and exposes patients to radiation. There are also biomarker tests that can detect Alzheimer’s, but they require invasive blood draws or lumbar punctures to obtain cerebrospinal fluid, which patients may be putting off.
        However, urine tests are non-invasive and convenient, making them ideal for mass screening. Although researchers have previously identified urine biomarkers for Alzheimer’s disease, none are suitable for detecting early stages of the disease, meaning the golden window for early treatment remains elusive.
        The researchers behind the new study have previously studied an organic compound called formaldehyde as a urine biomarker for Alzheimer’s disease. However, there is room for improvement in early disease detection. In this latest study, they focused on formate, a formaldehyde metabolite, to see if it works better as a biomarker.
        A total of 574 people took part in the study, and the participants were either cognitively normal healthy volunteers or had varying degrees of disease progression, from subjective cognitive decline to complete illness. The researchers analyzed urine and blood samples from the participants and conducted a psychological assessment.
        The study found that urinary formic acid levels were significantly elevated in all Alzheimer’s disease groups and correlated with cognitive decline compared to healthy controls, including the early subjective cognitive decline group. This suggests that formic acid may serve as a sensitive biomarker for the early stages of Alzheimer’s disease.
        Interestingly, when the researchers analyzed urine formate levels in combination with Alzheimer’s blood biomarkers, they found they could more accurately predict the stage of the disease a patient is going through. However, further research is needed to understand the link between Alzheimer’s disease and formic acid.
        “Urine formic acid has shown excellent sensitivity for early screening for Alzheimer’s disease,” the authors say. “Urine biomarker testing for Alzheimer’s disease is convenient and cost-effective and should be included in routine health screenings for the elderly.”
        Wang, Y. et al. (2022) Systematic review of urinary formic acid as a potential new biomarker for Alzheimer’s disease. Frontiers in the neurobiology of aging. doi.org/10.3389/fnagi.2022.1046066.
       Tags: aging, Alzheimer’s disease, biomarkers, blood, brain, chronic, chronic diseases, compounds, dementia, diagnostics, doctors, formaldehyde, neurology, positron emission tomography, research, tomography, urinalysis
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