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Welcome to the Dickerson Lab: New revised diagnostic criteria proposed for AD

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In July 2010 at the International AD meeting in Hawaii, groups of clinician-scientists, the Alzheimer's Association, and the National Institute on Aging announced newly proposed draft diagnostic criteria for AD. This received a great deal of media attention, much of which was somewhat misleading. The criteria proposed are for 3 different stages of AD. The third stage, AD dementia, is a revision of the original 1984 diagnostic criteria for how to diagnose AD in a patient who has dementia. This is an important advance that incorporates new imaging and biological measures, and could potentially be put into practice very soon. Many clinicians are already using such an approach.

The second stage, mild cognitive impairment (MCI) of the Alzheimer type, gives us a clearer approach for diagnosing AD in patients with very mild symptoms who do not yet fulfill criteria for dementia (loss of independent social or occupational function). Many of these patients are currently diagnosed with MCI, but in some cases it has been quite unclear what the cause may be. These criteria aim to provide guidance on how to determine whether the cause may be AD, using MRI and PET scans, as well as cerebrospinal fluid protein measures. In some cases this is already in practice, and will likely continue to make an important impact on practice as well as research as we move toward new methods to try to treat the illness at its very mild symptomatic stage.

Finally, the first stage is the "preclinical" stage, in which an individual may have evidence of brain amyloid (based on a research amyloid PET scan) or cerebrospinal fluid protein levels that are abnormal in a manner consistent with AD. These are currently research critera, and will require significantly more study before they can be put into practice. Yet they will likely be very important to harmonize the field for such studies, and to begin to enable doctors and scientists to think about how this stage of the disease could potentially be treated prior to symptoms, with the goal of delaying those symptoms.

We are currently in a public comment period, and details are provided on the Alzheimer's Association website.

I was interviewed on the Emily Rooney show on Boston's NPR radio station, along with Jim Wessler of the Alzheimer's Association, on July 15. The interview can be heard here.

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