Cited by 7,155Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsCancer-related cognitive impairment studies

Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease

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Sperling, Reisa A., Aisen, Paul S., Beckett, Laurel A., Bennett, David A., Craft, Suzanne, Fagan, Anne M., Iwatsubo, Takeshi, Jack, Clifford R. +13 more·2011·Alzheimer's & Dementia

Abstract

The pathophysiological process of Alzheimer's disease (AD) is thought to begin many years before the diagnosis of AD dementia. This long “preclinical” phase of AD would provide a critical opportunity for therapeutic intervention; however, we need to further elucidate the link between the pathological cascade of AD and the emergence of clinical symptoms. The National Institute on Aging and the Alzheimer's Association convened an international workgroup to review the biomarker, epidemiological, and neuropsychological evidence, and to develop recommendations to determine the factors which best predict the risk of progression from “normal” cognition to mild cognitive impairment and AD dementia. We propose a conceptual framework and operational research criteria, based on the prevailing scientific evidence to date, to test and refine these models with longitudinal clinical research studies. These recommendations are solely intended for research purposes and do not have any clinical implications at this time. It is hoped that these recommendations will provide a common rubric to advance the study of preclinical AD, and ultimately, aid the field in moving toward earlier intervention at a stage of AD when some disease‐modifying therapies may be most efficacious.

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Crossref · 10.1016/j.jalz.2011.03.003

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  • The susceptibility of the conventional criteria for MCI to diagnostic error is likely to be amplified if used to characterize and stage preclinical AD.

    “The susceptibility of the conventional criteria for MCI to diagnostic error is likely to be amplified if used to characterize and stage preclinical AD—a pre-MCI categorization based on subtle cognitive decline [8].”

    From Neuropsychological Criteria for Mild Cognitive Impairment Improves Diagnostic Precision, Biomarker Associations, and Progression Rates (2014) · cites this paper as [8]

    Section 3 describes people with very subtle decline who do not yet meet MCI criteria as part of preclinical AD. Section 9.3 adds that they may still score within the normal range on standard cognitive measures. These passages support the pre-MCI characterization, but do not say that conventional MCI criteria are susceptible to diagnostic error or that such error would be amplified when staging preclinical AD. Page numbers were not available in our copy. (LLM, conf=0.78)

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  • PiB and Florbetapir (AV45) amyloid tracers have shown greater cortical uptake in patients diagnosed with AD compared with control participants.

    “In PET imaging, PIB and Florbetapir (AV45) amyloid tracers have shown greater cortical uptake in patients diagnosed with AD compared with control participants 11,57 .”

    From OASIS-3: Longitudinal Neuroimaging, Clinical, and Cognitive Dataset for Normal Aging and Alzheimer Disease (2019) · cites this paper as [11]

    Section 5 describes increased PET amyloid-tracer retention as a biomarker of Alzheimer’s pathology, and the References name PiB imaging studies. However, the paper does not report that both PiB and Florbetapir (AV45) show greater cortical uptake in diagnosed AD patients than in controls; Florbetapir is not identified in the retrieved passages. (LLM, conf=0.83)

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  • Treatment will need to begin during the preclinical phase to prevent or limit plaque accumulation to be beneficial in reducing the risk of developing AD.

    “Several anti-Aβ therapeutic strategies are being pursued to treat AD; however, it is likely that treatment will need to begin during the preclinical phase to prevent or limit plaque accumulation to be beneficial in reducing the risk of developing AD (51, 52).”

    From Serotonin signaling is associated with lower amyloid-β levels and plaques in transgenic mice and humans (2011) · cites this paper as [52]

    The Introduction proposes preclinical treatment to lower Aβ burden and prevent later cognitive decline, and section 10 says amyloid-modifying drugs may be effective before symptoms begin (page numbers unavailable). But the paper presents this as a possibility to be tested, not an established likelihood that treatment must begin before plaque accumulates to reduce AD risk. (LLM, conf=0.84)

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  • New clinical diagnostic consensus criteria have now been finalized under the auspices of the NIA and Alzheimer's Association, with novel features including recognition of a preclinical stage of AD and the incorporation of imaging and laboratory-based cerebrospinal fluid biomarkers.

    “New clinical diagnostic consensus criteria have now been finalized under the auspices of the NIA and Alzheimer's Association (52), with novel features including recognition of a preclinical stage of AD and the incorporation of imaging and laboratory-based cerebrospinal fluid biomarkers.”

    From Accuracy of the Clinical Diagnosis of Alzheimer Disease at National Institute on Aging Alzheimer Disease Centers, 2005–2010 (2012) · cites this paper as [52]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • AD begins several decades before the clinical onset of dementia with progressive amyloid accumulation preceding significant tau pathology and neurodegeneration.

    “Alzheimer’s disease (AD) begins several decades before the clinical onset of dementia with progressive amyloid accumulation preceding significant tau pathology and neurodegeneration.10,11”

    From Machine learning reveals prominent spontaneous behavioral changes and treatment efficacy in humanized and transgenic Alzheimer's disease models (2024) · cites this paper as [11]

    The Introduction (page unavailable) says the AD process begins “years, if not decades” before clinical dementia, not that it consistently begins several decades earlier. Sections 2 and 4 describe amyloid accumulation as a hypothesized early event and tau pathology and neurodegeneration as downstream changes, but present that sequence as a proposed model rather than an established fact. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. [48]Becker JA Rentz D Carmasin JS Hedden T Hamdi I Buckner RL Amyloid deposition and brain volume across the continuum of aging and AD Ann Neurol 2011 in press

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Authors
Sperling, R. A., Aisen, P. S., Beckett, L. A., Bennett, D. A., Craft, S., Fagan, A. M., Iwatsubo, T., Jack, C. R., Kaye, J., Montine, T. J., Park, D. C., Reiman, E. M., Rowe, C. C., Siemers, E., Stern, Y., Yaffe, K., Carrillo, M. C., Thies, B., Morrison‐Bogorad, M., Wagster, M. V., & Phelps, C. H.
Affiliations
  • Brigham and Women's Hospital (US)
  • University of California San Diego (US)
  • University of California, Davis (US)
  • Rush University Medical Center (US)
  • University of Washington (US)
  • Washington University in St. Louis (US)
  • The University of Tokyo (JP)
  • Mayo Clinic (US)
  • Oregon Health & Science University (US)
  • The University of Texas at Dallas (US)
  • Banner Alzheimer’s Institute (US)
  • The University of Melbourne (AU)
  • Eli Lilly (United States) (US)
  • Columbia University Irving Medical Center (US)
  • San Francisco VA Medical Center (US)
  • Alzheimer's Association Chicago IL USA
  • Alzheimer's Association (US)
  • National Institutes of Health (US)
Corresponding author
Sperling, Reisa A.
Venue
Alzheimer's & Dementia
Publisher
Wiley
Published
2011-04-22
Volume
7
Issue
3
Pages
280-292
ISSN
  • 1552-5260 (ISSN-L)
  • 1552-5279
OpenAlex
W2129497119
Cited by
7,155
References
71
Citations by year
2026: 375 · 2025: 467 · 2024: 485 · 2023: 445 · 2022: 534 · 2021: 575 · 2020: 550 · 2019: 533 · 2018: 513 · 2017: 471 · 2016: 468 · 2015: 461 · 2014: 417 · 2013: 418 · 2012: 302
FWCI
277.90
Type
journal article
Language
en
Open access
Locations
  • Alzheimer s & Dementia (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Columbia Academic Commons (Columbia University)
Funders
  • National Institute on Aging
  • Pfizer
  • Baxter International
  • Johnson and Johnson
  • Eli Lilly and Company
  • Bayer
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
Keywords
Alzheimer's disease, preclinical Alzheimer's disease
MeSH terms
Alzheimer Disease, Cognition Disorders, Humans, United States, Biomarkers, Practice Guidelines as Topic, National Institute on Aging (U.S.)

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