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The National Institute on Aging and Alzheimer's Association research framework: A commentary from the Cochrane Dementia and Cognitive Improvement Group
Author(s) -
McCleery Jenny,
Flicker Leon,
Richard Edo,
Quinn Terence J.
Publication year - 2019
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.2018.10.007
Subject(s) - dementia , cognitive decline , gerontology , medicine , psychology , disease
Novel approaches to dementia research are urgently needed. In this context, the National Institute on Aging and Alzheimer’s Association (NIA-AA) have proposed a new paradigm [1]. In the Cochrane Dementia and Cognitive Improvement Group, we strive to offer an impartial synthesis of contemporary dementia research. At times, we have been a critical friend of the dementia research community, with the aim of raising standards and ultimately moving us closer to evidence-based treatments [2]. The Cochrane remit is clinical, and it is with the clinical relevance of the proposed framework that concerns us. Dementia is a complex and heterogeneous syndrome. Within this complexity, Alzheimer’s disease has an identifiable neuropathological signature which appears to contribute to the majority of dementia cases. But, there are nevertheless a large number of patients with dementia who fail to be neatly categorized by this or any of our other current biological constructs. What should we do in this situation? One solution would be to recognize the complexity of multiple disease processes with differing triggers for disease expression and to focus on the contribution (if any) of each specific biological construct to a specific clinical syndrome in an individual. The NIA-AA working group has taken a different approach, attempting instead to disentangle entirely the biological construct from the clinical picture. The NIA-AA proposals are presented as a research framework, not for use in clinical practice. However, research and practice do not exist in splendid isolation from each other. Clinical research exists to inform clinical practice, and so, the relevance of a framework which is explicitly unsuitable for use in clinical dialog must be questioned. We fear it is inevitable that this framework will, over time, encourage premature and inappropriate use of biomarkers in clinical practice. It is not possible to appropriate language and we have concern about the use of the term “Alzheimer’s disease” for research purposes. From a pragmatic research perspective,