This meeting is creating a forum for discussion among stakeholders - academics, regulators, industry and patients - in order to provide a first approximation for the resolution of issues in familial neurodegenrative disorders. Autosomal dominant Alzheimer's disease (ADAD) and Huntington's disease (HD) are being used as models to illustrate the challenges in pre-symptomatic clinical design studies. The insights obtained from this discussion are expected to be applicable to other similar areas.