Advisory Council April 2016 Meeting Presentation: Terminology Heterogeneity

04/29/2016

ADVISORY COUNCIL ON ALZHEIMER'S RESEARCH, CARE, AND SERVICES

Friday, April 29, 2016

 

Terminology Heterogeneity

Ronald C. Petersen, PhD, MD
Mayo Clinic

Dementia

Pie Chart: Alzheimer's Disease (53%), AD vascular dementia (10%), Vascular dementia (8%), Frontotemporal dementia (8%), Other (6%), DLB (5%), AD+ dementia with DLB (10%).

Multiple Terminologies

  • AD spectrum
  • ADRD
    • FTD
    • DLB
    • VCID
  • DSM-5
  • Dementia
  • MCI
  • Prodromal

Old Conception of Alzheimer’s Disease

Brain wave diagram: Cognitively Normal - Dementia.

Cognitive Continuum

Brain wave diagrams: Normal, MCI, and Dementia.

Alzheimer’s Disease Spectrum

Brain wave diagrams: Preclinical AD, MCI Due to AD, and Dementia Due to AD.

Alzheimer’s Disease Spectrum

Brain wave diagrams: Asymptomatic (Preclinical AD) - Symptomatic (MCI Due to AD and Dementia Due to AD).

Evolution of MCI Criteria Including Prodromal AD

Timelines: 1979 - 2013, 2007 - 2013.
Petersen, Continuum, in press

Diagram

  • Clinical Spectrum CN - MCI - Dementia [Clinical]
    • Aß [Pathology]
    • TAU [Pathology]
    • Other [Pathology]
    • Vascular Disease [Pathology]
    • Alpha Synuclein [Pathology]
    • TDP-43 [Pathology]

Diagram

  • Clinical Spectrum CN - MCI - Dementia [Clinical]
    • Aß [Pathology]
      • PET/CSF [Biomarker]
        • Rx? [Therapy]
    • TAU [Pathology]
      • PET/CSF [Biomarker]
        • Rx? [Therapy]
    • Other [Pathology]
      • ? [Biomarker]
        • Rx? [Therapy]
    • Vascular Disease [Pathology]
      • MRI [Biomarker]
        • Rx? [Therapy]
    • Alpha Synuclein [Pathology]
      • CSF? [Biomarker]
        • Rx? [Therapy]
    • TDP-43 [Pathology]
      • CSF? [Biomarker]
        • Rx? [Therapy]

 

Introduction to the Recommendations from the National Institute onAging-Alzheimer’s Association Workgroups on Diagnostic Guidelinesfor Alzheimer’s Disease

Clifford R. Jack, Jr, Marilyn S. Albert, David S. Knopman,Guy M. McKhann, Reisa A. Sperling, Maria C. Carrillo,Bill Thies, Creighton H. Phelps

Alz and Dementia, 2011

 

DSM 5

 

Mild Neurocognitive Disorder (MCI) Major Neurocognitive Disorder (Dementia)
Cognition
Independence
  1. Cognitive decline
  2. Single cognitive domain impaired (usually)
  3. Preservation of independence
  1. Cognitive decline
  2. Significant cognitive impairment in one or more often multiple cognitive domains
  3. Loss of independence

Mild Cognitive Impairment

Flow chart.
Petersen et al., J Int Med, 2013

Alzheimer’s Disease Spectrum

Brain wave diagrams: Preclinical AD, MCI Due to AD, and Dementia Due to AD.

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