Evolving Alzheimer's Disease Clinical Practice: Updated Diagnostic Criteria, Fluid Biomarkers, and Special Considerations for Anti-Amyloid Therapies - PubMed

8 days ago

The 2024 Alzheimer's Association (AA) revised criteria define Alzheimer's disease (AD) biologically, with A and T as core biomarkers.
Core 1 biomarkers can establish AD regardless of symptoms, while Core 2 biomarkers refine disease staging.
A two-cutoff strategy for blood-based biomarkers (BBMs) reduces misclassification and guides confirmatory testing with CSF or PET.
BBMs now approach the accuracy of CSF/PET for amyloid detection and are useful for triage, confirmation, and monitoring treatment response.
Integration of clinical stages (1-6) with biological stages (A-D) helps clarify syndrome-pathology discordance.
Special scenarios like maintenance after induction, APOE ε4 homozygotes, Down syndrome, and serious mental illness require individualized risk-benefit assessments.
In South Korea, constrained access to tau PET and some BBMs necessitates DSM-5-TR-anchored evaluation with selective biomarker testing.
Biomarker-oriented diagnosis and anti-amyloid therapies are reshaping AD care, with priorities including rigorous validation of BBMs and equitable access to core biomarkers.

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