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Age Ageing. 2019 Mar 1;48(2):174-177. doi: 10.1093/ageing/afy167.

When is Alzheimer's not dementia-Cochrane commentary on The National Institute on Ageing and Alzheimer's Association Research Framework for Alzheimer's Disease.

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Cochrane Dementia and Cognitive Improvement Group, University of Oxford, UK.
Western Australia Centre for Health & Ageing, University of Western Australia, Perth, Australia.
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.


Early 2018 saw the release of new diagnostic guidance on Alzheimer's disease from the National Institute on Ageing and the Alzheimer's Association (NIA-AA). This proposed research framework represents a fundamental change in how we think about Alzheimer's disease, moving from diagnosis based on clinical features to diagnosis based solely on biomarkers. These recommendations are contentious and have important implications for patients, clinicians, policy makers and the pharmaceutical industry. In this commentary, we offer a summary of the NIA-AA research framework. We then focus on five key areas: divorcing neuropathology from the clinical syndrome; the emphasis placed on one dementia subtype; validity of available biomarkers; the changing meaning of the term 'Alzheimer's disease'; and the potential for a research framework to influence clinical practice.


Alzheimer’s disease; Cochrane; biomarkers; dementia; evidence-based medicine; older people; research


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