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Toward a consensus recommendation for defining the asymptomatic‐preclinical phases of putative Alzheimer's disease?
Author(s) -
Khachaturian Zaven S.,
Mesulam M. Marsel,
Mohs Richard C.,
Khachaturian Ara S.
Publication year - 2016
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2016.02.003
Subject(s) - section (typography) , library science , dementia , citation , asymptomatic , computer science , medicine , psychology , gerontology , disease , pathology , operating system
This perspective reflects the proceedings of the workshop—“The Preclinical State of AD” on July 23, 2015 in Washington DC, USA organized by the Alzheimer’s Association and the International Working Group The title of this editorial reflects the wish of Alzheimers & Dementia to announce the establishment of a clinically meaningful and scientifically sound framework for defining and characterizing the initial stages of “Alzheimer’s disease” (AD), from the first speck of amyloid deposition to the onset of consequential cognitive impairment. At the same time, the question mark we placed at the end of the title reflects an all too obvious acknowledgment of the immense challenges that continue to face this goal. All agree that severeADpathology (definedby thepresence of plaques and tangles in high density and wide distribution) is almost always associated with incapacitating dementia. Also, agreement exists that AD pathology and its resultant dementia do not arise overnight. There is a recognition of a lengthy and immensely complex cascade of events that eventually links the accumulation of plaques and tangles to the synaptic dysfunction underlying the cognitive impairment. In a perfect world, a single unerring valid marker (with 100% sensitivity and 100% specificity) of emerging or impending AD pathology would coexist with a completely safe and uniformly effective preventive intervention that could halt the neurodegenerative cascade. In a slightly imperfect world, if there existed a completely safe, uniformly effective, and affordable preventive intervention, it would be prescribed to everyone above a certain age without concern about the accuracy of the marker. And in a slightly more imperfect world, if the preventive intervention led to serious adverse events in a subset of patients who could not be identified and excluded before the start of treatment, there would be a high demand for an extremely accurate marker. Such a marker would not solely identify the underlying pathology but also the probability of the consequential cognitive impairment onset within the lifespan of the individual. But, in the highly imperfect world