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

Alternative Approaches

In our view, this guidance goes beyond what was needed for its stated aims. Better communication about biomarkers and better characterisation of trial participants for interventions targeting a highly specific mechanism could be achieved by a purely descriptive vocabulary, such as the ATN labels, without linking these to disease categories. This would be consistent with the reality that cognitive impairment arises in a multidimensional space in which the nature and degree of proteinopathy is only one factor determining whether or not an individual will develop cognitive decline. This 'space' in which symptoms are determined can look quite different from different perspectives and may be influenced by the organisation of services and the politics of research funding as well as by biology. Alternatives to a model which relies on discrete diagnostic labels are available. Dementia could be the prototypical condition which would benefit from a research framework eschewing dichotomisation (disease/no disease) and embracing instead a model focused on patient prognosis and the likelihood of future outcome.[11]