New Diagnostic Criteria for Alzheimer's Disease
MCI due to AD refers to the symptomatic phase of the AD pathophysiological process before the individual develops the functional impairment that defines dementia. The guidelines presented by Albert et al recognise that everyone who eventually develops AD goes through a transitional period of mild but detectable cognitive impairment. However, not everyone who is diagnosed with MCI goes on to develop AD. MCI can be due to several disorders, including vascular dementia, frontotemporal dementia, dementia with Lewy bodies, and others. Furthermore, distinguishing between normal cognition and MCI, and between MCI and dementia needs clinical judgment.
The criteria for MCI due to AD include:
First, criteria are presented for the clinical and cognitive syndrome of MCI, and second, criteria are presented regarding the aetiology of the MCI syndrome being consistent with AD (Table 5).
Criteria for MCI due to AD incorporating biomarkers (Table 1) are next presented. Biomarkers of Aβ protein deposition may help determine aetiology, and markers of neurodegeneration may aid prognosis. If one of these two biomarker categories is positive, the 'biomarker probability of AD aetiology' rises to 'intermediate'; both categories must be positive for the 'highest' probability. The 'lowest' probability is present if both categories are negative.
Criteria for MCI Due to AD
MCI due to AD refers to the symptomatic phase of the AD pathophysiological process before the individual develops the functional impairment that defines dementia. The guidelines presented by Albert et al recognise that everyone who eventually develops AD goes through a transitional period of mild but detectable cognitive impairment. However, not everyone who is diagnosed with MCI goes on to develop AD. MCI can be due to several disorders, including vascular dementia, frontotemporal dementia, dementia with Lewy bodies, and others. Furthermore, distinguishing between normal cognition and MCI, and between MCI and dementia needs clinical judgment.
The criteria for MCI due to AD include:
excluding patients with other causes of MCI, including extensive vascular disease, frontotemporal dementia, and dementia with Lewy bodies
including patients with increasing cognitive decline over time
including patients with mutations associated with early-onset familial AD (amyloid precursor protein, presenilin 1 or presenilin 2).
First, criteria are presented for the clinical and cognitive syndrome of MCI, and second, criteria are presented regarding the aetiology of the MCI syndrome being consistent with AD (Table 5).
Criteria for MCI due to AD incorporating biomarkers (Table 1) are next presented. Biomarkers of Aβ protein deposition may help determine aetiology, and markers of neurodegeneration may aid prognosis. If one of these two biomarker categories is positive, the 'biomarker probability of AD aetiology' rises to 'intermediate'; both categories must be positive for the 'highest' probability. The 'lowest' probability is present if both categories are negative.
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