Commentary on “Diagnosis of Alzheimer's disease: Two decades of progress.” Symptomatology and biomolecular basis of Alzheimer's: A synthesis

The twentieth anniversary of Zaven Khachaturian’s landark publication “Diagnosis of Alzheimer’s disease” [1,2] s a fitting occasion to describe an emerging view that ntegrates research into the nature of clinical symptoms in lzheimer’s disease (AD) with basic biomolecular neuroevelopmental observations, as well as pathophysiologic eatures of AD. The new view of AD that will be described erein is the product of continuous research extending for ore than a quarter century, primarily supported by the ational Institute on Aging (NIA) of the US National Intitutes of Health (NIH). Zaven Khachaturian personally layed an important role in supporting this research in his fficial capacity as the person most directly in charge of the IA AD extramural research effort for many crucial years. e also personally encouraged this work. This personal ncouragement is an infrequently acknowledged, but psyhologically essential, aspect of the advancement of scienific knowledge. Traditional assessments of the clinical magnitude and ature of dementia pathology combined symptoms more or ess arbitrarily to produce a total score [3–5]. I took a ifferent approach to clinical measure development begining in 1978. This was to combine actual observation of atient symptoms (ie, an empirical approach), with a hierrchic approach based on perceived severity levels. An ffort was made to select symptoms that were optimally niversal. Beginning with a 7-point scale (normal, very ild, mild, etc.), the result of these observations was a eries of scales describing the evolution of aging and AD athology. These included the Global Deterioration Scale