A National Institute on Aging and Alzheimer's Association (NIA-AA) workgroup has released revised criteria for the diagnosis and staging  of Alzheimer disease (AD) based on biologic markers rather than syndromic presentation. The new criteria, developed in response to advances in AD biomarkers and approved anti-amyloid therapies, aim to offer objective standards for diagnosing and staging AD and to bridge the gap between research and clinical care.  

The revised criteria introduce the concept of Core 1 (early-changing) and Core 2 (later-changing) biomarkers. Core 1 biomarkers (amyloid positron emission tomography [PET], cerebrospinal fluid [CSF] markers, and plasma markers) indicate early AD neuropathologic change (ADNPC) and are sufficient for diagnostic confirmation of AD, even in asymptomatic individuals. Core 2 biomarkers (tau PET and biofluid markers) can be used to confirm AD pathology and to stage biologic disease severity. 

The NIA-AA workgroup also proposes an integrated AD biologic and clinical staging scheme that shows the relationship between biomarkers and symptoms while acknowledging that copathologies, cognitive reserve, and resistance may modify this relationship. 

Source: Jack CR, Andrews, JS, Beach TG, et al. Revised criteria for diagnosis and staging of Alzheimer’s disease: Alzheimer’s Association workgroup. Alzheimer’s Dement. June 2024:1–27. doi:10.1002/alz.13859