Impact of the IWG/Dubois Criteria for Alzheimer’s Disease in Imaging Studies

The NINCDS-ADRA concept of AD diagnosis (1984)

The IWG concept of AD diagnosis (2007)

The diagnosis of AD cannot be certified clinically and needs a postmortem confirmation to be ascertained

Pathological biomarkers can be considered as surrogate markers of the underlying AD pathology

Therefore, the clinical diagnosis of AD can only be “probable” and can only be made when the disease is advanced and reaches the threshold of dementia

Therefore, the clinical diagnosis can be established in vivo and no more reference to dementia is needed

Glossary

Alzheimer’s disease (AD)

The whole clinical phase, no longer restricted to the dementia syndrome.

AD dementia

When cognitive symptoms interfere with activity of daily living.

Alzheimer’s pathology

Underlying neurobiological changes responsible for AD.

Asymptomatic at risk

Cognitively normal individuals with positive pathophysiological biomarkers.

Atypical AD

Less common but well-characterized clinical phenotypes that occur with Alzheimer’s pathology. The diagnosis of AD needs in vivo evidence of pathophysiological markers.

Mixed AD

Patients who fulfill the criteria for AD and additionally present with clinical and biomarkers evidence of other comorbid disorders.

Mild cognitive impairment (MCI)

Patients for whom there is no disease clearly identified.

Pathophysiological markers

Biological changes that reflect the underlying AD pathology (CSF changes; PET amyloid). They are markers of diagnosis.

Presymptomatic AD

Cognitively normal individuals with a proven AD autosomal dominant mutation.

Prodromal AD

The early symptomatic, predementia phase of AD.

Topographical biomarkers

Downstream markers of neurodegeneration that can be structural (MRI) or metabolic (FDG-PET). They are markers of progression.

Typical AD

The most common clinical phenotype of AD, characterized by an amnestic syndrome of the hippocampal type.

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