Although no official statement was made concerning the acceptability of MCI as a therapeutic target, many experts interpreted the FDA’s position that MCI is very early dementia, most likely AD. Further elaboration of this issue will likely require submission by industry of drugs for MCI to the FDA for consideration for approval. The regulatory process in the USA is relatively open. Whether or not experts believe that a diagnostic entity is an Inhibitors,research,lifescience,medical appropriate target for drug development influences the regulators in the evaluation of protocols. Europe The European Medicines

Evaluation Agency (EMEA) has not held open hearings about the concept of MCI. Individual members of their committees have spoken at scientific meetings. Such presentations suggest Inhibitors,research,lifescience,medical that the attitude in Europe is similar to that in the USA, ie, the

regulators will wait for more development in the field and for the submission of actual trials. Canada In the fall of 2004, a group of investigators in Canada will meet to examine the draft academic guidelines that were issued several years ago. Regulators will be involved in the meeting, and the topic of MCI and related conditions will be discussed. It is uncertain whether these guidelines will be considered official government position. Asia No regulatory bodies in Asia have taken a stance on MCI as a Inhibitors,research,lifescience,medical target condition. Under the auspices of the International Working Group for the Harmonization of Dementia Drug Guidelines, organized for the first time 8 years ago by the author and currently by Jean-Marc

Inhibitors,research,lifescience,medical Orgogozo, three Asian regional meetings have been held. From the first in Singapore in 2001, to the second in China, and now this year in Thailand, there has been growing interest in the concept of MCI among academic opinion leaders in Asia.28,29 Of course, this is largely influenced Inhibitors,research,lifescience,medical by the Western experts expressing their enthusiasm for the concept. Attitudes toward the elderly and to age-related cognitive changes are different in Asia. The back-translation into English of the term, MCI, by a leading opinion leader in China is “loss of wisdom” (Prof Xu, personal communication). Labeling millions of Chinese with this Edoxaban term has some interesting social implications and potentially profound effects on attitudes toward the elderly in China. International issues A variety of international professional organizations have organized meetings about MCI. The International Working Group for the Harmonization of Dementia Drug Guidelines has had regulatory issues at the heart of its mission to promote global discussion about designs to treat MCI, AD, and other conditions like vascular dementia. Currently under the direction of Lon find more Schneider with input from other experts, including the author, a manuscript addressing regulatory aspects of drug development for MCI is being prepared.