diagnostic criteria for Alzheimer's disease
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Diagnostic criteria
clinical diagnosis
- development of multiple cognitive deficits
- memory impairment must be present
- one or more of the following cognitive disturbances
- aphasia
- apraxia
- agnosia
- disturbance in executive function
- significant impairment on social or occupational functioning representing a significant decline from a previous level of functioning
- gradual onset & progressive cognitive decline
- cognitive deficits are not due to
- other central nervous system conditions that cause progressive deficits in memory & cognition
- systemic conditions known to cause dementia
- substance-induced conditions
- deficits do not occur exclusively during episodes of delirium
- disturbance is NOT better accounted for by another axis I disorder (i.e. schizophrenia)
- CERAD[6]
ATN classification system based on biomarkers (research)*[5]
- beta-amyloid deposition
- neurofibrillary tau
- neurodegeneration[5]
Alzheimer's Association Workgroup[7]
- AD is a biological process that begins with the appearance of AD neuropathologic changes (neuritic plaques & neurofibrillaty tangles) while people are asymptomatic
- progression of the neuropathologic burden leads to the later appearance & progression of clinical symptoms
- early-changing Core 1 biomarkers (amyloid PET), approved CSF biomarkers, & plasma biomarkers (plasma ptau-217) map onto the AD neuropathologic changes
- an abnormal Core 1 biomarker result is sufficient to establish a diagnosis of AD & to inform clinical decision making throughout the disease continuum
- later-changing Core 2 biomarkers (biofluid, tau PET) can provide prognostic information, & if abnormal, increase confidence that symptoms are due to AD[7]
Staging
Alzheimer's Association Workgroup[7]
- an integrated biological & clinical staging scheme that accommodates the fact that common copathologies, cognitive reserve, & resistance may modify relationships between clinical & biological AD stages[7]
Braak staging[5]: A4 deposition & neurofibrillary tangles
- distribution of amyloid plaques varies widely
- stage A: basal neocortical areas
- stage B: superiolateral spread
- stage C: extension into primary neocortical areas
- six stages distinguished by location and severity of changes
- trans-entorhinal stages I-II: clinically silent
- involvement confined
- limbic stages III-IV: incipient AD
- involvement of CA1
- neocortical stages V-VI: fully developed AD
- involvement of all areas of association cortex
- trans-entorhinal stages I-II: clinically silent
* biomarkers from imaging & biofluids[5]
* although it is possible that beta-amyloid plaques & neurofibrillary tangles are not causal in Alzheimer's disease (AD) pathogenesis, it is these abnormal deposits that define AD as a unique neurodegenerative disease among different disorders that can result in dementia[5]
More general terms
References
- ↑ Role of cholinergic therapy in treatment of Alzheimer's disease & other dementias, Farlow, M et al, 2001
- ↑ DSM IV
- ↑ Jack CR Jr, Albert MS, Knopman DS et al Introduction to the recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):257-62. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21514247
- ↑ McKhann GM, Knopman DS, Chertkow H 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. Alzheimers Dement. 2011 May;7(3):263-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21514250
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Jack CR Jr, Bennett DA, Blennow K et al NIA-AA Research Framework: Toward a biological definition of Alzheimer's disease. Alzheimers & Dementia. April 2018, 14(4):535-562 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29653606 <Internet> http://www.alzheimersanddementia.com/article/S1552-5260(18)30072-4/fulltext
Jack CR Jr, Bennett DA, Blennow K et al A/T/N: An unbiased descriptive classification scheme for Alzheimer disease biomarkers. Neurology. 2016 Aug 2;87(5):539-47. Epub 2016 Jul 1. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27371494 Free PMC Article - ↑ 6.0 6.1 Mirra et al. The consortium to establish a registry for Alzheimer's disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease. Neurology 41:479-486, 1991 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2011243
Gearing et al. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part X. Neuropathology confirmation of the clinical diagnosis of Alzheimer's disease. Neurology 45:461-6 1995. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/7898697
<Internet> http://www.alzforum.org/dis/dia/cli/Consensus.asp
http://www-cfas.medschl.cam.ac.uk/neuro_forms.htm - ↑ 7.0 7.1 7.2 7.3 7.4 Jack CR Jr, Andrews JS, Beach TG et al Revised criteria for diagnosis and staging of Alzheimer's disease: Alzheimer's Association Workgroup. Alzheimers Dement. 2024 Jun 27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38934362 https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.13859
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