Alzheimer Disease as a Clinical-Biological Construct-An International Working Group Recommendation.

IF 20.4 1区 医学 Q1 CLINICAL NEUROLOGY JAMA neurology Pub Date : 2024-11-01 DOI:10.1001/jamaneurol.2024.3770
Bruno Dubois, Nicolas Villain, Lon Schneider, Nick Fox, Noll Campbell, Douglas Galasko, Miia Kivipelto, Frank Jessen, Bernard Hanseeuw, Mercè Boada, Frederik Barkhof, Agneta Nordberg, Lutz Froelich, Gunhild Waldemar, Kristian Steen Frederiksen, Alessandro Padovani, Vincent Planche, Christopher Rowe, Alexandre Bejanin, Agustin Ibanez, Stefano Cappa, Paulo Caramelli, Ricardo Nitrini, Ricardo Allegri, Andrea Slachevsky, Leonardo Cruz de Souza, Andrea Bozoki, Eric Widera, Kaj Blennow, Craig Ritchie, Marc Agronin, Francisco Lopera, Lisa Delano-Wood, Stéphanie Bombois, Richard Levy, Madhav Thambisetty, Jean Georges, David T Jones, Helen Lavretsky, Jonathan Schott, Jennifer Gatchel, Sandra Swantek, Paul Newhouse, Howard H Feldman, Giovanni B Frisoni
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Abstract

Importance: 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 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.

Objective: 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.

Evidence review: 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.

Findings: 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.

Conclusions and relevance: 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.

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作为临床生物结构的阿尔茨海默病--国际工作组建议书。
重要性:自 2018 年以来,出现了根据生物标志物研究结果将阿尔茨海默病(AD)定义为纯生物实体的运动。阿尔茨海默病协会(AA)最近对阿尔茨海默病标准的修订进一步推动了这一方向。然而,人们对将 AD 的纯生物学定义应用于临床、整个社会对 AD 的理解以及将基于血液的生物标记物转化为临床实践等问题的担忧,促使国际工作组(IWG)提出了这些最新建议:考虑修订后的AA标准,并为AD提供另一种定义视角,将其作为一种临床生物结构用于临床。对 2021 年 IWG 诊断标准的建议进行了更新,以进一步阐述高危状态和症状前状态:使用术语 "生物标志物 "或 "淀粉样蛋白 "或 "tau "或 "神经变性 "或 "临床前 "或 "CSF "或 "PET "或 "血浆 "和 "阿尔茨海默病 "检索 PubMed 上 2020 年 7 月 1 日至 2024 年 3 月 1 日期间发表的文章。还检索了相关文章的参考文献:在新的 AA 诊断标准中,AD 在临床上可被定义为包括认知正常且具有 1 个核心 AD 生物标志物的人。然而,最近的文献显示,大多数生物标志物阳性的认知正常人不会在近似时间内出现症状。在临床环境中,对认知正常但只有核心 1 AD 生物标志物的人进行 AD 诊断,是纯生物学疾病定义的最大问题所在:该领域的最终目标是促进有效的注意力缺失症治疗,包括预防症状和痴呆症。在不清楚何时或是否会出现症状的情况下,在没有临床和生物学建构的情况下诊断注意力缺失症的方法是毫无根据的,而且可能会令人担忧。建议不要将仅淀粉样蛋白阳性的人,以及大多数生物标志物阳性的认知正常的人贴上注意力缺失症的标签。相反,他们应被视为有患注意力缺失症的风险。对于那些具有特定生物标志物模式的人来说,扩大无症状 AD 的范围被视为一种更好的诊断方法,表明他们在不久的将来就会出现症状。
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来源期刊
JAMA neurology
JAMA neurology CLINICAL NEUROLOGY-
CiteScore
41.90
自引率
1.70%
发文量
250
期刊介绍: JAMA Neurology is an international peer-reviewed journal for physicians caring for people with neurologic disorders and those interested in the structure and function of the normal and diseased nervous system. The Archives of Neurology & Psychiatry began publication in 1919 and, in 1959, became 2 separate journals: Archives of Neurology and Archives of General Psychiatry. In 2013, their names changed to JAMA Neurology and JAMA Psychiatry, respectively. JAMA Neurology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.
期刊最新文献
Deferiprone in Alzheimer Disease: A Randomized Clinical Trial. Immediate or Delayed Statin in Acute Atherosclerotic Ischemia. Immediate or Delayed Statin in Acute Atherosclerotic Ischemia-Reply. Remembering the Physician's Humanity-Physicians Are Humans Too. Alzheimer Disease as a Clinical-Biological Construct-An International Working Group Recommendation.
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