UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Challenges in a Biological Definition of Alzheimer Disease

Hazan, Jemma; Liu, Kathy Y; Costello, Harry; Isaacs, Jeremy D; Thambisetty, Madhav; Howard, Robert; (2024) Challenges in a Biological Definition of Alzheimer Disease. Neurology , 103 (9) , Article e209884. 10.1212/WNL.0000000000209884. Green open access

[thumbnail of Hazan_et-al-2024-challenges-in-a-biological-definition-of-alzheimer-disease.pdf]
Preview
Text
Hazan_et-al-2024-challenges-in-a-biological-definition-of-alzheimer-disease.pdf

Download (157kB) | Preview

Abstract

It has been suggested that the diagnostic landscape of Alzheimer disease (AD) is undergoing a profound transformation, marked by a shift toward a biomarker-based approach, as proposed by the Revised Criteria for Diagnosis and Staging of Alzheimer's Disease. These criteria advocate for diagnosing AD solely on biomarkers, without requiring clinical symptoms. This article explores the drivers behind this transition, primarily influenced by the Food and Drug Administration's approval of amyloid-lowering treatments. We evaluate the proposed criteria, which allow for an AD diagnosis based on amyloid "A" or phosphorylated tau "T1" positivity through surrogate amyloid PET imaging, CSF, or plasma biomarkers, and consider the arguments for and against their use. The merits of the new criteria include a clearer definition of AD, which is currently used interchangeably to refer to both the presence of neuropathology and the clinical syndrome. We argue that a purely biological definition risks a category error and emphasize the need for longitudinal data to establish the lifetime risk of dementia in amyloid-positive and tau-positive individuals. We also caution against limiting the scope of biomarker-based AD diagnosis to amyloid and tau alone. In conclusion, we recommend that the criteria remain within the research domain for the present while advocating for the considered adoption of plasma biomarkers in clinical practice.

Type: Article
Title: Challenges in a Biological Definition of Alzheimer Disease
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1212/WNL.0000000000209884
Publisher version: https://doi.org/10.1212/wnl.0000000000209884
Language: English
Additional information: Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY) (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry > Mental Health of Older People
URI: https://discovery.ucl.ac.uk/id/eprint/10203601
Downloads since deposit
Loading...
1Download
Download activity - last month
Loading...
Download activity - last 12 months
Loading...
Downloads by country - last 12 months
1.United Kingdom
1

Archive Staff Only

View Item View Item