Hazan, J; Liu, KY; Costello, H; Isaacs, JD; Thambisetty, M; Howard, R
(2024)
Challenges in a Biological Definition of Alzheimer Disease.
NEUROLOGY, 103 (9).
e209884.
ISSN 0028-3878
https://doi.org/10.1212/WNL.0000000000209884
SGUL Authors: Isaacs, Jeremy
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Abstract
It has been suggested that the diagnostic landscape of Alzheimer disease (AD) is undergoing a profound transformation, marked by a shift toward a biomarker-based approach, as proposed by the Revised Criteria for Diagnosis and Staging of Alzheimer's Disease. These criteria advocate for diagnosing AD solely on biomarkers, without requiring clinical symptoms. This article explores the drivers behind this transition, primarily influenced by the Food and Drug Administration’s approval of amyloid-lowering treatments. We evaluate the proposed criteria, which allow for an AD diagnosis based on amyloid “A” or phosphorylated tau “T1” positivity through surrogate amyloid PET imaging, CSF, or plasma biomarkers, and consider the arguments for and against their use. The merits of the new criteria include a clearer definition of AD, which is currently used interchangeably to refer to both the presence of neuropathology and the clinical syndrome. We argue that a purely biological definition risks a category error and emphasize the need for longitudinal data to establish the lifetime risk of dementia in amyloid-positive and tau-positive individuals. We also caution against limiting the scope of biomarker-based AD diagnosis to amyloid and tau alone. In conclusion, we recommend that the criteria remain within the research domain for the present while advocating for the considered adoption of plasma biomarkers in clinical practice.
Item Type: | Article |
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Additional Information: | Correction available at https://doi.org/10.1212/WNL.0000000000210200 Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | 1103 Clinical Sciences, 1109 Neurosciences, 1702 Cognitive Sciences, Neurology & Neurosurgery |
SGUL Research Institute / Research Centre: | Academic Structure > Neuroscience & Cell Biology Research Institute Academic Structure > Neuroscience & Cell Biology Research Institute > Neurological Disorders & Imaging |
Journal or Publication Title: | NEUROLOGY |
ISSN: | 0028-3878 |
Publisher License: | Creative Commons: Attribution 4.0 |
Web of Science ID: | WOS:001325469500001 |
URI: | https://openaccess.sgul.ac.uk/id/eprint/116950 |
Publisher's version: | https://doi.org/10.1212/WNL.0000000000209884 |
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