Skip to main content Accessibility help

The application of stratified medicine to dementia care

  • Emad Sidhom (a1), John O'Brien (a2) and Benjamin R. Underwood (a3)


Stratified medicine has been successfully used in many areas of medicine, perhaps most notably oncology. There is now both a growing evidence base and mounting enthusiasm, supported at a governmental level and across industry, academia and clinical medicine, to apply this approach to neurodegenerative illnesses, including dementia, as these provide the greatest clinical and social challenge of our times. In this article we consider definitions of stratified medicine, look at its application in other medical specialties, review the national context in the UK and consider the current state, future potential and specific considerations of applying stratified medicine to dementia.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The application of stratified medicine to dementia care
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The application of stratified medicine to dementia care
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The application of stratified medicine to dementia care
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.

Corresponding author

Correspondence Dr Emad Sidhom. Email:


Hide All
National Institute for Health and Care Excellence (2003) Guidance on the Use of Electroconvulsive Therapy (Technology Appraisal Guidance TA59). NICE.
Association of the British Pharmaceutical Industry (2014) Stratified medicine in the NHS. ABPI ( Accessed 29 Jan 2020.
Academy of Medical Sciences (2020) Stratified medicine. Academy of Medical Sciences ( Accessed 29 Jan 2020.
Cancer Research UK (2020) Breast cancer statistics. Cancer Research UK ( Accessed 30 Jan 2020.
National Institute for Health Research (2020) Clinical Research Network. NIHR ( Accessed 30 Jan 2020.
Berrios, GE (1990) Alzheimer's disease: a conceptual history. International Journal of Geriatric Psychiatry, 5: 355–65.
Blandini, F, Cilia R, Cerri S, et al. (2019) Glucocerebrosidase mutations and synucleinopathies: toward a model of precision medicine. Movement Disorders, 34: 921.
Blennow, K, Zetterberg, H (2015) The past and the future of Alzheimer's disease CSF biomarkers – a journey toward validated biochemical tests covering the whole spectrum of molecular events. Frontiers in Neuroscience, 9: 345.
Corder, EH, Saunders, AM, Strittmatter, WJ, et al. (1993) Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. Science, 261: 921–3.
Courtney, C, Farrell, D, Gray, R, et al. (2004) Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. Lancet, 363: 2105–15.
Cubo, E, Shannon, KM, Tracy, D, et al. (2006) Effect of donepezil on motor and cognitive function in Huntington disease. Neurology, 67: 1268–71.
Cummings, J, Lee, G, Ritter, A, et al. (2019) Alzheimer's disease drug development pipeline: 2019. Alzheimer's and Dementia, 5: 272–93.
Debnath, M (2010) Omics Technology. In Molecular Diagnostics: Promises and Possibilities (eds M Debnath M, GB Prasad, PS Bisen): 11–31. Springer.
Erkkinen, MG, Kim, MO, Geschwind, MD (2018) Clinical neurology and epidemiology of the major neurodegenerative diseases. Cold Spring Harbor Perspectives in Biology, 10(4): a033118.
Ersek, JL, Black, LJ, Thompson, MA, et al. (2018) Implementing precision medicine programs and clinical trials in the community-based oncology practice: barriers and best practices. American Society of Clinical Oncology Educational Book, 38: 188–96.
Ferrari, R, Manzoni, C, Hardy, J (2019) Genetics and molecular mechanisms of frontotemporal lobar degeneration: an update and future avenues. Neurobiology of Aging, 78: 98110.
Flaherty, KT, Robert, C, Hersey, P, et al. (2012) Improved survival with MEK inhibition in BRAF-mutated melanoma. New England Journal of Medicine, 367: 107–14.
Freudenberg-Hua, Y, Li, W, Davies, P (2018) The role of genetics in advancing precision medicine for Alzheimer's Disease-A narrative review. Frontiers in Medicine, 5: 108.
Goate, A, Chartier-Harlin, MC, Mullan, M, et al. (1991) Segregation of a missense mutation in the amyloid precursor protein gene with familial Alzheimer's disease. Nature, 349: 704–6.
Hampel, H, Vergallo, A, Giorgi, FS, et al. (2018) Precision medicine and drug development in Alzheimer's disease: the importance of sexual dimorphism and patient stratification. Frontiers in Neuroendocrinology, 50: 3151.
Jabbari, E, Holland, N, Chelban, V, et al. (2019) Diagnosis across the spectrum of progressive supranuclear palsy and corticobasal syndrome. JAMA Neurology. Available from:
Jordan, VC (2006) Tamoxifen (ICI46,474) as a targeted therapy to treat and prevent breast cancer. British Journal of Pharmacology [Epub ahead of print], Dec 20. Available from:
Kaemmerer, WF, Grondin, R (2019) The effects of huntingtin-lowering: what do we know so far? Degenerative Neurological and Neuromuscular Disease, 9: 317.
Klunk, WE, Engler, H, Nordberg, A, et al. (2004) Imaging brain amyloid in Alzheimer's disease with Pittsburgh compound-B. Annals of Neurology, 55: 306–19.
Lam, B, Hollingdrake, E, Kennedy, JL, et al. (2009) Cholinesterase inhibitors in Alzheimer's disease and Lewy body spectrum disorders: the emerging pharmacogenetic story. Human Genomics, 4: 91106.
Lenz, C, Steffen, JA, Engelsberg, A (2013) Molecular testing guidelines for selection of lung cancer patients for ALK tyrosine kinase inhibitors. Journal fur Pharmakologie und Therapie, 22: 45–8.
Matthews, FE, Stephan, BC, Robinson, L, et al. (2016) A two decade dementia incidence comparison from the Cognitive Function and Ageing Studies I and II. Nature Communications, 7: 11398.
McCall, WV, Reboussin, DM, Weiner, RD, et al. (2000) Titrated moderately suprathreshold vs fixed high-dose right unilateral electroconvulsive therapy. Archives of General Psychiatry, 57: 438–44.
Mercado, G, Hetz, C (2017) Drug repurposing to target proteostasis and prevent neurodegeneration: accelerating translational efforts. Brain, 140: 1544–7.
Michels, S, Wolf, J (2016) Stratified treatment in lung cancer. Oncology Research and Treatment, 39: 760–6.
Mo, JJ, Li, JY, Yang, Z, et al. (2017) Efficacy and safety of anti-amyloid-β immunotherapy for Alzheimer's disease: a systematic review and network meta-analysis. Annals of Clinical and Translational Neurology, 4: 931–42.
Molinuevo, JL, et al. (2018) Current state of Alzheimer's fluid biomarkers. Acta Neuropathologica, 136: 821–53.
Moraes, F, Góes, A (2016) A decade of human genome project conclusion: scientific diffusion about our genome knowledge. Biochemistry and Molecular Biology Education, 44: 215–23.
Motter, R, Vigo-Pelfrey, C, Kholodenko, D, et al. (1995) Reduction of β-amyloid peptide42 in the cerebrospinal fluid of patients with Alzheimer's disease. Annals of Neurology, 38: 643–8.
Nikolac Perkovic, M, Pivac, N (2019) Genetic markers of Alzheimer's disease. Advances in Experimental Medicine and Biology, 1192: 2752.
Quirke, VM (2017) Tamoxifen from failed contraceptive pill to best-selling breast cancer medicine: a case-study in pharmaceutical innovation. Frontiers in Pharmacology, 8: 620.
Ravikumar, B, Vacher, C, Berger, Z, et al. (2004) Inhibition of mTOR induces autophagy and reduces toxicity of polyglutamine expansions in fly and mouse models of Huntington disease. Nature Genetics, 36: 585–95.
Rizzo, G, Arcuti, S, Copetti, M, et al. (2018) Accuracy of clinical diagnosis of dementia with Lewy bodies: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery and Psychiatry, 89: 358–66.
Sackeim, HA, Decina, P, Kanzler, M, et al. (1987) Effects of electrode placement on the efficacy of titrated, low-dose ECT. American Journal of Psychiatry, 144: 1449–55.
Slamon, DJ, Leyland-Jones, B, Shak, S, et al. (2001) Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. New England Journal of Medicine, 344: 783–92.
Sloane, PD, Zimmerman, S, Suchindran, C, et al. (2002) The public health impact of Alzheimer's disease, 2000–2050: potential implication of treatment advances. Annual Review of Public Health, 23: 213–31.
Soverini, S, Abruzzese, E, Bocchia, M, et al. (2019) Next-generation sequencing for BCR-ABL1 kinase domain mutation testing in patients with chronic myeloid leukemia: a position paper. Journal of hematology & oncology, 12: 131.
Stelzmann, RA, Schnitzlein, HN, Murtagh, FR (1995) An English translation of Alzheimer's 1907 paper, “Über eine eigenartige Erkankung der Hirnrinde”. Clinical Anatomy, 8: 429–31.
Strittmatter, WJ, Saunders, AM, Schmechel, D, et al. (1993) Apolipoprotein E: high-avidity binding to beta-amyloid and increased frequency of type 4 allele in late-onset familial Alzheimer disease. PNAS, 90: 1977–81.
Summers, WK, Viesselman, JO, Marsh, GM, et al. (1981) Use of THA in treatment of Alzheimer-like dementia: pilot study in twelve patients. Biological Psychiatry, 16: 145–53.
Tabrizi, SJ, Leavitt, BR, Landwehrmeyer, GB, et al. (2019) Targeting huntingtin expression in patients with Huntington's disease. New England Journal of Medicine, 380: 2307–16.
Trusheim, MR, Burgess, B, Hu, SX, et al. (2011) Quantifying factors for the success of stratified medicine. Nature Reviews Drug Discovery, 10: 817–33.
Venter, JC, Adams, MD, Myers, EW, et al. (2001) The sequence of the human genome. Science, 291: 1304–51.
Yu, H, Burton, B, Huang, CJ, et al. (2012) Ivacaftor potentiation of multiple CFTR channels with gating mutations. Journal of Cystic Fibrosis, 11(3): 237–45.


Type Description Title
Supplementary materials

Sidhom et al. supplementary material
Sidhom et al. supplementary material

 Unknown (3.5 MB)
3.5 MB

The application of stratified medicine to dementia care

  • Emad Sidhom (a1), John O'Brien (a2) and Benjamin R. Underwood (a3)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.