Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria.
The NINCDS-ADRDA and the DSM-IV-TR criteria for Alzheimer's disease (AD) are the prevailing diagnostic standards in research; however, they have now fallen behind the unprecedented growth of scientific knowledge. Distinctive and reliable biomarkers of AD are now available through structural MRI, molecular neuroimaging with PET, and cerebrospinal fluid analyses. This progress provides the impetus for our proposal of revised diagnostic criteria for AD. Our framework was developed to capture both the earliest stages, before full-blown dementia, as well as the full spectrum of the illness. These new criteria are centred on a clinical core of early and significant episodic memory impairment. They stipulate that there must also be at least one or more abnormal biomarkers among structural neuroimaging with MRI, molecular neuroimaging with PET, and cerebrospinal fluid analysis of amyloid beta or tau proteins. The timeliness of these criteria is highlighted by the many drugs in development that are directed at changing pathogenesis, particularly at the production and clearance of amyloid beta as well as at the hyperphosphorylation state of tau. Validation studies in existing and prospective cohorts are needed to advance these criteria and optimise their sensitivity, specificity, and accuracy.
Dubois
Bruno
B
INSERM U610, Hôpital de la Salpêtrière, Paris, France. bruno.dubois@psl.aphp.fr
Feldman
Howard H
HH
Jacova
Claudia
C
Dekosky
Steven T
ST
Barberger-Gateau
Pascale
P
Cummings
Jeffrey
J
Delacourte
André
A
Galasko
Douglas
D
Gauthier
Serge
S
Jicha
Gregory
G
Meguro
Kenichi
K
O'brien
John
J
Pasquier
Florence
F
Robert
Philippe
P
Rossor
Martin
M
Salloway
Steven
S
Stern
Yaakov
Y
Visser
Pieter J
PJ
Scheltens
Philip
P
D000544:Alzheimer Disease / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis*; D016229:Amyloid beta-Peptides / Q000134:cerebrospinal fluid; D003952:Diagnostic Imaging / Q000379:methods; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D006801:Humans; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology; D009316:National Institutes of Health (U.S.) / Q000592:standards; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D016875:tau Proteins / Q000134:cerebrospinal fluid
D016229:Amyloid beta-Peptides; D016875:tau Proteins