Journal Article (Editorial)

DZNE-2024-01406

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Alzheimer Disease as a Clinical-Biological Construct-An International Working Group Recommendation.

Dubois, B. ; Villain, N. ; Schneider, L. ; Fox, N. ; Campbell, N. ; Galasko, D. ; Kivipelto, M. ; Jessen, F.DZNE* ; Hanseeuw, B. ; Boada, M. ; Barkhof, F. ; Nordberg, A. ; Froelich, L. ; Waldemar, G. ; Frederiksen, K. S. ; Padovani, A. ; Planche, V. ; Rowe, C. ; Bejanin, A. ; Ibanez, A. ; Cappa, S. ; Caramelli, P. ; Nitrini, R. ; Allegri, R. ; Slachevsky, A. ; de Souza, L. C. ; Bozoki, A. ; Widera, E. ; Blennow, K. ; Ritchie, C. ; Agronin, M. ; Lopera, F. ; Delano-Wood, L. ; Bombois, S. ; Levy, R. ; Thambisetty, M. ; Georges, J. ; Jones, D. T. ; Lavretsky, H. ; Schott, J. ; Gatchel, J. ; Swantek, S. ; Newhouse, P. ; Feldman, H. H. ; Frisoni, G. B.

2024
American Medical Association Chicago, Ill.

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Please use a persistent id in citations: doi:10.1001/jamaneurol.2024.3770

Abstract: Since 2018, a movement has emerged to define Alzheimer disease (AD) as a purely biological entity based on biomarker findings. The recent revision of the Alzheimer's Association (AA) criteria for AD furthers this direction. However, concerns about a purely biological definition of AD being applied clinically, the understanding of AD by society at large, and the translation of blood-based biomarkers into clinical practice prompt these International Working Group (IWG) updated recommendations.To consider the revised AA criteria and to offer an alternative definitional view of AD as a clinical-biological construct for clinical use. The recommendations of the 2021 IWG diagnostic criteria are updated for further elaborating at-risk and presymptomatic states.PubMed was searched for articles published between July 1, 2020, and March 1, 2024, using the terms 'biomarker' OR 'amyloid' OR 'tau' OR 'neurodegeneration' OR 'preclinical' OR 'CSF' OR 'PET' OR 'plasma' AND 'Alzheimer's disease.' The references of relevant articles were also searched.In the new AA diagnostic criteria, AD can be defined clinically as encompassing cognitively normal people having a core 1 AD biomarker. However, recent literature shows that the majority of biomarker-positive cognitively normal individuals will not become symptomatic along a proximate timeline. In the clinical setting, disclosing a diagnosis of AD to cognitively normal people with only core 1 AD biomarkers represents the most problematic implication of a purely biological definition of the disease.The ultimate aim of the field was to foster effective AD treatments, including preventing symptoms and dementia. The approach of diagnosing AD without a clinical and biological construct would be unwarranted and potentially concerning without a clear knowledge of when or whether symptoms will ever develop. It is recommended that those who are amyloid-positive only and, more generally, most biomarker-positive cognitively normal individuals, should not be labeled as having AD. Rather, they should be considered as being at risk for AD. The expansion of presymptomatic AD is viewed as a better diagnostic construct for those with a specific pattern of biomarkers, indicating that they are proximate to the expression of symptoms in the near future.

Keyword(s): Biomarkers: analysis (MeSH) ; Alzheimer Disease: diagnosis (MeSH) ; Humans (MeSH) ; Biomarkers (MeSH) ; Biomarkers

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Contributing Institute(s):

1. Clinical Alzheimer’s Disease Research (AG Jessen)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

Appears in the scientific report 2024

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; Essential Science Indicators ; IF >= 25 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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