New Diagnostic Criteria and Guidelines For Alzheimer's Disease

in brief
for healthcare professionals
April 2011 alz.org

New Diagnostic Criteria and Guidelines for Alzheimer’s Disease
Expert workgroups spearheaded by the Alzheimer’s Association and the National Institute on Aging of the National
Institutes of Health have developed new criteria and guidelines for the diagnosis of Alzheimer’s disease which are now
available online through the Alzheimer’s & Dementia:The Journal of the Alzheimer’s Association.
Go to alz.org/detectionDX for more information.
The new criteria and guidelines include recommendations for clinical office settings and research settings as illustrated by
the following Summary Table.
Summary Table. Criteria and Guidelines for Alzheimer’s Disease

Clinical Use Research Use
Stage of Alzheimer’s Disease Tests/Criteria Clinical or Research Use
Introduction Notable differences from 1984 Broad consensus that use of biomarkers
Intro
(Jack et al, 2011) NINCDS-ADRDA criteria include must be validated and standardized
formulation of 3 AD stages and before routine clinical application.
inclusion of biomarkers.
Dementia due to Alzheimer’s 1. Probable AD dementia (core 1. Probable AD dementia criteria

Disease clinical criteria) – includes meeting retained the framework of the 1984
(McKhann et al, 2011) the clinical criteria for all-cause NINCDS-ADRDA criteria and can be
dementia along with insidious used in the clinical setting.
Includes 3 sets of criteria: onset; clear history of worsening of
cognition by report or observation;
1. Probable AD dementia and initial and most prominent
cognitive deficits include amnestic
presentation and/or deficits in
language presentation, visuospatial
Dementia due to AD
presentation and executive

function.
2. Possible AD dementia 2. Possible AD dementia – 2. Possible AD dementia criteria can be
diagnosis for patients who meet used in the clinical setting. Any patient
core clinical criteria but exhibit an with previous possible AD dementia
atypical course of cognitive decline per the 1984 NINCDS-ADRDA criteria
or mixed etiological presentation. should be reevaluated with the updated
criteria.
3. Probable AD dementia
with evidence of AD 3. Probable AD dementia with 3. It is not recommended to use
pathophysiology evidence of AD pathophysiology biomarker tests for routine AD diagnosis.
– diagnosis for patients who If undertaken, biomarker evidence may
meet the core clinical criteria increase the certainty that clinically
and incorporate biomarkers, assessed dementia is due to the AD
advanced imaging and evaluation of pathological process.
biochemical changes.
Summary Table. Criteria and Guidelines for Alzheimer’s Disease (continued)
Clinical Use Research Use
Stage of Alzheimer’s Disease Tests/Criteria Clinical or Research Use
Mild Cognitive Impairment due 1. Core clinical criteria - clinical 1. Core clinical criteria can be used in
to Alzheimer’s Disease and cognitive assessments that clinical settings.
(Albert et al, 2011) establish concern of change in
cognition over time; impairment
Includes 2 sets of criteria: in 1 or more cognitive domain;
MCI due to AD
preservation of independence in
1. Core clinical criteria functional abilities; not demented,
and etiology of MCI consistent with
AD, including where relevant, AD
genetic factors.
2. Research criteria
2. Research criteria – incorporates 2. Research criteria established solely
biomarkers, advanced imaging and for the purpose of research. Workgroup
evaluation of biochemical changes noted that prior to use in community
with probabilistic framework settings, validation of biomarker criteria
for levels of certainty for MCI and standardization of biomarker analyses
due to AD. must occur.
Preclinical Preclinical criteria incorporates Preclinical criteria established solely for

(Sperling et al, 2011) biomarkers /advanced imaging. the purpose of research.
Measure of Aβ accumulation This is a conceptual model and is not

Preclinical
A new conceptual phase to

encompass individuals with (CSF Aβ42 and PET imaging with meant to imply that all individuals with
pathophysiological changes in the amyloid tracer). early AD pathology will progress to
brain but are cognitively normal clinical AD dementia.
(no evidence of dementia or mild Measure of neuronal injury
cognitive impairment). (CSF tau/p-tau, FDG-PET/fMRI,
and sMRI).
Abbreviations: Aβ = amyloid beta; AD = Alzheimer’s disease; CSF = cerebral spinal fluid; FDG = fluorodeoxyglucose;
fMRI = functional magnetic resonance imaging; MCI = mild cognitive impairment; MRI = magnetic resonance imaging; PET = positron emission tomography;
NINCDS-ADRDA = criteria for the clinical diagnosis of AD published in 1984 by the National Institutes of Neurologic and Communicative Disorders and Stroke and
the Alzheimer’s Disease and Related Disorders Association workgroup; sMRI = structural magnetic resonance imaging
References
Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institutes on
Aging and the Alzheimer’s Association workgroup. Alzheimer’s & Dementia 2011 Apr 20.(online and In Press)
Jack CR, Albert MS, Knopman DS, et al. Introduction to the recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup on
diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia 2011 Apr 20.(online and In Press)
McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institutes on Aging and the
Alzheimer’s Association workgroup. Alzheimer’s & Dementia 2011 Apr 20.(online and In Press)
Sperling RA, Aisen PS, Beckett LA, at el. Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging and the
Alzheimer’s Association workgroup. Alzheimer’s & Dementia 2011 Apr 20.(online and In Press)
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in brief

for healthcare professionals

April 2011 alz.org

Summary Table. Criteria and Guidelines for Alzheimer’s Disease

Stage of Alzheimer’s Disease Tests/Criteria Clinical or Research Use

Dementia due to Alzheimer’s 1. Probable AD dementia (core 1. Probable AD dementia criteria

presentation and executive

Stage of Alzheimer’s Disease Tests/Criteria Clinical or Research Use

Preclinical Preclinical criteria incorporates Preclinical criteria established solely for

Measure of Aβ accumulation This is a conceptual model and is not

A new conceptual phase to

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