The purpose of this conference is to develop the conceptual basis for making a clinical diagnosis of Alzheimer's Disease (AD) at an earlier stage than currently accepted criteria would allow, i.e., at a predementia or preclinical stage. The NINCDS-ADRDA criteria for AD were developed twenty two years ago with the basic premise that the diagnosis of Alzheimer's disease was essentially a process of exclusion. Since that time there have been major advances in understanding the biological basis of Alzheimer's disease, in defining the clinical presentation and the differential diagnosis, through the development and refinement of neuropsychological, brain imaging and other biological markers, and understanding its epidemiology in different populations. Current concepts regarding AD suggest that the pathology of the disease begins many years before the clinical manifestations and that various measures known to improve general health and prevent cardiovascular disease may substantially delay the clinical manifestations of the disease, i.e. the onset of dementia. Advances in treatments for Alzheimer's disease continue to be made, so that an earlier diagnosis of AD will allow secondary preventive methods as well as active treatments to be initiated early in the disease course. The goal of this conference is to develop a level of agreement regarding the feasibility of achieving an earlier diagnosis of AD with sufficiently high accuracy by the use of new inclusive as well as exclusive criteria derived from the history, cognitive assessments, brain imaging tests and other biomarkers. Among the major issues that will need to be addressed in this conference are: (1)Validation: correlation of the structural and molecular pathology of AD to qualitative and quantitative abnormalities found on clinical evaluation and on diagnostic tests; (2) Predictive utility, individually and collectively, of clinical assessment by history and examination, neuropsychological, neuroimaging and biomarker tests in the diagnosis of early AD in tertiary care and research settings;(3) Applicability of these assessments to make an earlier diagnosis of AD in clinical trials, population studies, general clinical practice and among special populations such as ethnic minorities; (4) External impact: the medical, public health policy, social, legal, and ethical ramifications of making an earlier diagnosis of AD; (5) The feasibility of integrating the results of various assessments so as to develop algorithms and formal criteria for making a diagnosis of early AD in various settings. Project Relevance: Alzheimer's disease affects as many as 4.5 million persons in the United States, with a dramatic increase in numbers expected in the next 30 years. The disease is often overwhelming for caregivers, both emotionally and financially. Many recent developments in the diagnosis of Alzheimer's disease demonstrate that this diagnosis can be made earlier than is the current practice, and thereby allow various promising medical interventions to be initiated early in the disease. ? ? ? ? ? ? ? ?
| Burke, Shanna L; Rodriguez, Miriam J; Barker, Warren et al. (2018) Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia. J Int Neuropsychol Soc 24:176-187 |
