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

Separating the Clinical From the Pathological—a Messy Divorce

A recurring theme in the materials is that '(clinical symptoms) are neither sensitive nor specific for the neuropathologic changes that define the disease'. It is true that many individuals with a clinical picture of amnestic cognitive decline do not have the expected AD biomarker profile and that this may have had consequences for trials of interventions based on the amyloid hypothesis. However, it is equally true that many with a biomarker profile that would be labelled 'Alzheimer's' in the new guidance are cognitively unimpaired and will remain so for the rest of their lives.[5] In fact, one could turn the statement round and say that the biomarkers are not sufficiently sensitive or specific for the clinical syndrome. We must ask ourselves what is the 'target condition' here? In other words, which is more important to clinicians, patients and the public, the neuropathological signature or the clinical symptoms?