When Is Alzheimer's Not Dementia—Cochrane Commentary on the National Institute on Ageing and Alzheimer's Association Research Framework for Alzheimer's Disease

Jenny Mccleery; Leon Flicker; Edo Richard; Terence J. Quinn


Age Ageing. 2019;48(2):174-177. 

In This Article


Following publication of the framework, the NIA-AA invited comment and discussion. There has been substantial positive published comment, often from specialist centres already experienced in the use of biomarkers. There have even been calls for the immediate application of the framework in the clinic, particularly to support reimbursement of biomarker tests in insurance-based systems. However, critical voices have also been raised at recent scientific meetings.

Our remit in the Cochrane Dementia Group is to provide evidence-based appraisal of developments in dementia research and practice. We have previously been a critical friend of the 2011 diagnostic guidance, commenting that the evidence supporting biomarker-based diagnosis was not yet definitive and that wide-scale adoption would be premature.[4] Our concerns are magnified in relation to the new framework. Some of the aims of the new guidance are clearly laudable. For example, better biological characterisation of trial participants should allow for more efficient studies and a common language with which to discuss the complex field of AD biomarkers is needed. However, we believe that this new guidance has some serious and worrying conceptual and practical implications that should be widely debated.