Revised criteria for diagnosis and staging of Alzheimer's disease: Alzheimer's Association Workgroup

IF 13 1区医学 Q1 CLINICAL NEUROLOGY

Alzheimer's & Dementia Pub Date : 2024-06-27 DOI:10.1002/alz.13859

Clifford R. Jack Jr., J. Scott Andrews, Thomas G. Beach, Teresa Buracchio, Billy Dunn, Ana Graf, Oskar Hansson, Carole Ho, William Jagust, Eric McDade, Jose Luis Molinuevo, Ozioma C. Okonkwo, Luca Pani, Michael S. Rafii, Philip Scheltens, Eric Siemers, Heather M. Snyder, Reisa Sperling, Charlotte E. Teunissen, Maria C. Carrillo

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引用次数: 0

Abstract

The National Institute on Aging and the Alzheimer's Association convened three separate work groups in 2011 and single work groups in 2012 and 2018 to create recommendations for the diagnosis and characterization of Alzheimer's disease (AD). The present document updates the 2018 research framework in response to several recent developments. Defining diseases biologically, rather than based on syndromic presentation, has long been standard in many areas of medicine (e.g., oncology), and is becoming a unifying concept common to all neurodegenerative diseases, not just AD. The present document is consistent with this principle. Our intent is to present objective criteria for diagnosis and staging AD, incorporating recent advances in biomarkers, to serve as a bridge between research and clinical care. These criteria are not intended to provide step-by-step clinical practice guidelines for clinical workflow or specific treatment protocols, but rather serve as general principles to inform diagnosis and staging of AD that reflect current science.

Highlights

We define Alzheimer's disease (AD) to be a biological process that begins with the appearance of AD neuropathologic change (ADNPC) while people are asymptomatic. Progression of the neuropathologic burden leads to the later appearance and progression of clinical symptoms.
Early-changing Core 1 biomarkers (amyloid positron emission tomography [PET], approved cerebrospinal fluid biomarkers, and accurate plasma biomarkers [especially phosphorylated tau 217]) map onto either the amyloid beta or AD tauopathy pathway; however, these reflect the presence of ADNPC more generally (i.e., both neuritic plaques and tangles).
An abnormal Core 1 biomarker result is sufficient to establish a diagnosis of AD and to inform clinical decision making throughout the disease continuum.
Later-changing Core 2 biomarkers (biofluid and tau PET) can provide prognostic information, and when abnormal, will increase confidence that AD is contributing to symptoms.
An integrated biological and clinical staging scheme is described that accommodates the fact that common copathologies, cognitive reserve, and resistance may modify relationships between clinical and biological AD stages.

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阿尔茨海默病诊断和分期修订标准：阿尔茨海默氏症协会工作组。

美国国家老龄化研究所和阿尔茨海默病协会于 2011 年分别召集了三个工作组，并于 2012 年和 2018 年召集了单个工作组，为阿尔茨海默病（AD）的诊断和定性提出建议。本文件更新了 2018 年的研究框架，以应对最近的几项进展。从生物学角度而非基于综合征表现来定义疾病，早已成为许多医学领域（如肿瘤学）的标准，并正在成为所有神经退行性疾病（而不仅仅是 AD）的共同概念。本文件符合这一原则。我们的目的是结合生物标记物的最新进展，提出诊断和分期 AD 的客观标准，作为研究和临床治疗之间的桥梁。这些标准并非旨在为临床工作流程或具体治疗方案提供循序渐进的临床实践指南，而是作为反映当前科学水平的 AD 诊断和分期的一般原则。要点：我们将阿尔茨海默病（AD）定义为一种生物过程，始于无症状时出现的 AD 神经病理改变（ADNPC）。神经病理学负担的加重会导致临床症状的出现和发展。早期变化的核心 1 生物标记物（淀粉样蛋白正电子发射断层扫描 [PET]、经批准的脑脊液生物标记物和准确的血浆生物标记物 [尤其是磷酸化 tau 217]）映射到淀粉样蛋白 beta 或 AD tauopathy 途径；但是，这些标记物更广泛地反映了 ADNPC 的存在（即神经元斑块和神经元缠结）。核心 1 生物标志物的异常结果足以确定 AD 诊断，并为整个疾病过程中的临床决策提供依据。后期变化的核心2生物标志物（生物流体和tau PET）可提供预后信息，一旦异常，将增加对AD导致症状的信心。本文介绍了一个综合的生物和临床分期方案，该方案考虑到了共同病理、认知储备和抵抗力可能会改变 AD 临床分期和生物分期之间的关系这一事实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alzheimer's & Dementia 医学-临床神经学

CiteScore

14.50

自引率

5.00%

发文量

299

审稿时长

3 months

期刊介绍： Alzheimer's & Dementia is a peer-reviewed journal that aims to bridge knowledge gaps in dementia research by covering the entire spectrum, from basic science to clinical trials to social and behavioral investigations. It provides a platform for rapid communication of new findings and ideas, optimal translation of research into practical applications, increasing knowledge across diverse disciplines for early detection, diagnosis, and intervention, and identifying promising new research directions. In July 2008, Alzheimer's & Dementia was accepted for indexing by MEDLINE, recognizing its scientific merit and contribution to Alzheimer's research.