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The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease.
Literature Information
| DOI | 10.1016/j.jalz.2011.03.005 |
|---|---|
| PMID | 21514250 |
| Journal | Alzheimer's & dementia : the journal of the Alzheimer's Association |
| Impact Factor | 11.1 |
| JCR Quartile | Q1 |
| Publication Year | 2011 |
| Times Cited | 6970 |
| Keywords | Alzheimer's disease, diagnostic criteria, biomarkers |
| Literature Type | Consensus Development Conference, NIH, Journal Article, Research Support, Non-U.S. Gov't |
| ISSN | 1552-5260 |
| Pages | 263-9 |
| Issue | 7(3) |
| Authors | Guy M McKhann, David S Knopman, Howard Chertkow, Bradley T Hyman, Clifford R Jack, Claudia H Kawas, William E Klunk, Walter J Koroshetz, Jennifer J Manly, Richard Mayeux, Richard C Mohs, John C Morris, Martin N Rossor, Philip Scheltens, Maria C Carrillo, Bill Thies, Sandra Weintraub, Creighton H Phelps |
TL;DR
The workgroup commissioned by the National Institute on Aging and the Alzheimer's Association revised the criteria for Alzheimer's disease (AD) dementia to make them adaptable for both general healthcare providers and specialized researchers. The updated criteria maintain the foundational framework from 1984 while integrating biomarker evidence to enhance diagnostic specificity, emphasizing the need for further validation of these biomarkers in clinical and research settings.
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Alzheimer's disease · diagnostic criteria · biomarkers
Abstract
The National Institute on Aging and the Alzheimer's Association charged a workgroup with the task of revising the 1984 criteria for Alzheimer's disease (AD) dementia. The workgroup sought to ensure that the revised criteria would be flexible enough to be used by both general healthcare providers without access to neuropsychological testing, advanced imaging, and cerebrospinal fluid measures, and specialized investigators involved in research or in clinical trial studies who would have these tools available. We present criteria for all-cause dementia and for AD dementia. We retained the general framework of probable AD dementia from the 1984 criteria. On the basis of the past 27 years of experience, we made several changes in the clinical criteria for the diagnosis. We also retained the term possible AD dementia, but redefined it in a manner more focused than before. Biomarker evidence was also integrated into the diagnostic formulations for probable and possible AD dementia for use in research settings. The core clinical criteria for AD dementia will continue to be the cornerstone of the diagnosis in clinical practice, but biomarker evidence is expected to enhance the pathophysiological specificity of the diagnosis of AD dementia. Much work lies ahead for validating the biomarker diagnosis of AD dementia.
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Primary Questions Addressed
- What are the specific changes made to the clinical criteria for diagnosing Alzheimer's disease dementia compared to the 1984 guidelines?
- How does the integration of biomarker evidence improve the diagnostic process for Alzheimer's disease dementia in both clinical and research settings?
- What are the implications of retaining the term "possible AD dementia" with a more focused definition in the context of diagnosis and treatment?
- In what ways can general healthcare providers effectively utilize the revised diagnostic criteria without access to advanced diagnostic tools?
- What further research is needed to validate the use of biomarker evidence in the diagnosis of Alzheimer's disease dementia?
Key Findings
Research Background and Objectives
The workgroup formed by the National Institute on Aging and the Alzheimer’s Association aimed to revise the diagnostic criteria for Alzheimer's disease (AD) dementia established in 1984. The objective was to create flexible criteria applicable to both general healthcare providers and specialized researchers, ensuring that the revised guidelines reflect advancements in clinical understanding, biomarker integration, and the clinical spectrum of AD.
Main Methods/Materials/Experimental Design
The workgroup conducted a comprehensive review of existing criteria, incorporating modern innovations in clinical assessments, neuropsychological testing, and biomarker evaluations. The revised criteria include:
Core Clinical Criteria for All-Cause Dementia:
- Cognitive or behavioral symptoms that interfere with daily functioning.
- A decline from previous levels of functioning.
- Impairment in at least two cognitive domains.
Proposed Classification Criteria for AD Dementia:
- Probable AD Dementia: Insidious onset, clear cognitive decline, and specific cognitive deficits.
- Possible AD Dementia: Atypical presentations or evidence of mixed etiologies.
- Probable or Possible AD Dementia with Biomarker Evidence: Incorporation of biomarkers to enhance diagnostic certainty.
Key Results and Findings
- The revised criteria retain the framework of probable AD dementia while updating clinical features based on new evidence.
- Integration of biomarkers such as amyloid-beta levels and tau protein measurements enhances diagnostic specificity.
- A new classification system distinguishes between probable and possible AD dementia and incorporates evidence of AD pathophysiological processes.
Main Conclusions/Significance/Innovation
The revised criteria for diagnosing AD dementia represent a significant advancement in clinical practice and research. They provide a more nuanced understanding of AD, accommodating atypical presentations and the role of biomarkers. This flexibility is crucial for both clinical settings and research environments, allowing for more accurate diagnoses and better patient management.
Research Limitations and Future Directions
- Limitations: The implementation of biomarkers is not yet standardized across all clinical settings, and their routine use in diagnosis remains limited. Additionally, the criteria need further validation through ongoing research.
- Future Directions: Further studies are needed to refine the use of biomarkers in clinical practice, establish standardized protocols, and explore the integration of genetic factors in diagnosing AD. Research should also focus on enhancing the understanding of the preclinical stages of AD and its heterogeneous presentations.
Summary Table
| Aspect | Details |
|---|---|
| Research Objective | Revise diagnostic criteria for AD dementia |
| Core Criteria | Cognitive decline affecting daily life, impairment in multiple domains |
| Classification | Probable, Possible, with Biomarker Evidence |
| Biomarkers | Amyloid-beta, tau protein, neuroimaging |
| Limitations | Standardization of biomarkers, need for further validation |
| Future Research | Focus on genetic factors, preclinical stages, and standardization efforts |
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Literatures Citing This Work
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