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NIA commentary on the NIA‐AA Research Framework: Towards a biological definition of Alzheimer's disease
Author(s) -
Silverberg Nina,
Elliott Cerise,
Ryan Laurie,
Masliah Eliezer,
Hodes Richard
Publication year - 2018
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.2018.03.004
Subject(s) - gerontology , library science , medicine , computer science
Over 47 million people world-wide are living with dementia, the great majority of them due to Alzheimer’s disease (AD) [1]. Studies in diverse populations, comorbid conditions, and disease heterogeneity are now at the forefront of research given the added complexity posed for diagnosing AD with precision and selecting populations for clinical trials. For instance, unless characterized by biomarkers, it is possible that over 30% of the individuals recruited for natural history and clinical trials studies might display pathologies other than AD [2]. Moreover, recent postmortem studies have shown a considerable heterogeneity in the neuropathology of those dying with dementia in their 80s or older [3]. Adding more to the complexity, recent studies have shown those dying with dementia in their 80s or older could be suffering from AD-mimics such as Primary Age Related Taupathy (PART) [4], Age Related Tau Astrogliopathy (ARTAG) [5–7], and Cerebral Age-Related TDP-43 With Sclerosis (CARTS), also known as hippocampal sclerosis [4]. Given the urgent need to better understand the natural history of AD, the high prevalence of mimics in these populations, and the need to develop effective treatments, it has become clear that we need better operational definitions to concepts of AD to provide a common language for investigators conducting not only clinical trials research, but also natural history and other research studies where the specific disease course or biology is being investigated (e.g., efforts to develop less expensive biomarkers). Such efforts will allow more precise estimates of how many people are at risk or suffer from AD, how best to monitor response to therapies, and how to distinguish the effects of AD from other similar pathologies. Furthermore, such studies will allow better understanding of the heterogeneity of AD. This is crucial in terms of fulfilling the primary goal of the National Plan for Alzheimer’s Disease that calls for finding a treatment for AD by the year 2025 [8]. In 2011, the National Institute on Aging (NIA) and the Alzheimer’s Association (AA) formed a workgroup to update the original recommendations formulated in 1984 [9] by the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the