UPDATE: Fourth set of guidelines regarding the neuropathologic assessment of Alzheimer's disease now published.

Three expert international workgroups convened by the Alzheimer's Association and the National Institute on Aging (NIA) have issued the first new criteria and guidelines to diagnose Alzheimer's disease in 27 years. The new guidelines update, refine and broaden widely used guidelines published in 1984 by the Alzheimer's Association (then known as the Alzheimer's Disease and Related Disorders Association) and the National Institute of Neurological and Communicative Disorders and Stroke (now known as the National Institute of Neurological Disorders and Stroke).

The new guidelines appear as free-access papers in Alzheimer's and Dementia: The Journal of the Alzheimer's Association and are available as PDFs below.

These updated criteria and guidelines result from work that began two years ago, when more than 40 Alzheimer's researchers and clinicians from around the globe began in-depth review of the original criteria to decide how they might be improved by incorporating research advances from the last three decades.

Each workgroup released its proposed recommendations at the 2010 Alzheimer's Association International Conference on Alzheimer's Disease (AAICAD). Following release, these recommendations were posted here until October 2010 for public comment. The workgroups revised the final versions of the guidelines to reflect input from the professional community at large.

A core value of Alzheimer's & Dementia: The Journal of the Alzheimer's Association is open peer dialog and commentary. Guideline authors and the journal's editors welcome and encourage further comments on the published guidelines.

The new diagnostic criteria and guidelines include the following key elements:

• Updates to widely used existing guidelines for Alzheimer's disease originally established in 1984 by the National Institute of Neurological Disorders and Stroke (NINDS) and the Alzheimer's Association.
• Refinements to existing guidelines for diagnosing mild cognitive impairment (MCI). People with MCI experience a decline in memory, reasoning or visual perception that's measurable and noticeable to themselves or to others, but not severe enough to be diagnosed as Alzheimer's or another dementia. The new guidelines formalize an emerging consensus that everyone who eventually develops Alzheimer's experiences this stage of minimal but detectable impairment, even though it's not currently diagnosed in most people. However, not everyone with with MCI eventually develops Alzheimer's, because MCI may also occur for other reasons. The guidelines designate the condition of minimal impairment preceding Alzheimer's as "MCI due to Alzheimer's disease," and define four levels of certainty for arriving at this diagnosis.
• Expansion of the conceptual framework for thinking about Alzheimer's disease to include a "preclinical" stage characterized by signature biological changes (biomarkers) that occur years before any disruptions in memory, thinking or behavior can be detected. The new guidelines do not yet specify which biomarkers should be considered signatures of preclinical Alzheimer's. Instead, they propose a research agenda that builds on promising preliminary data emerging from recent studies, including the federally funded Alzheimer's Disease Neuroimaging Initiative (ADNI). Promising investigational biomarkers include brain imaging strategies and certain proteins in spinal fluid.
• Establishment of a framework for eventually adding biomarker benchmarks to the diagnosis of Alzheimer's disease in all of its stages. The guidelines for MCI due to Alzheimer's disease include specific biomarkers for use in research settings, with the expectation that these recommendations are a work in progress that will evolve as knowledge advances. The guidelines for dementia due to Alzheimer's disease also propose a research agenda to increase diagnostic certainty by incorporating biomarkers into the diagnosis. Understanding signature biomarkers may reveal how these benchmarks change over time, enabling more precise and clinically useful characterization of the full spectrum of Alzheimer's. These insights may pave the way for more effective treatments targeted at signature pathological processes at work in specific stages.

 

More information

 

Alzheimer's Association news release

FAQ on the new criteria and guidelines

National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease from Alzheimer's and Dementia: The Journal of the Alzheimer's Association

Clifford R. Jack Jr., et al. "Introduction to the recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease"

Guy M. McKhann and David S. Knopman, et al. "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"

Workgroup members: Proposed criteria for Alzheimer's disease dementia

Marilyn S. Albert, et al. "The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer's disease"

Workgroup members: Proposed criteria for mild cognitive impairment due to Alzheimer's disease

Reisa A. Sperling, et al. "Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease"

Workgroup members: Proposed criteria for preclinical Alzheimer's disease

 

Guidelines Regarding Neuropathologic Assessment

The NIA and Alzheimer's Association released a fourth set of proposed guidelines regarding neuropathologic assessment at AAIC 2011. A final version is published in the January 2012 issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

Bradley T. Hyman, et al. "National Institute on Aging–Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease"

 

 

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