Revamping of Alzheimer’s Diagnosis Guidelines Introduces New Seven-Point Rating Scale

Experts in the field of Alzheimer’s disease are introducing a new rating scale to improve the diagnosis of patients with the progressive brain disorder. The proposed guidelines, unveiled at an Alzheimer’s Association conference in Amsterdam, aim to create a numerical staging system similar to the one used in cancer diagnoses. This new system will replace the previous guidelines issued in 2018 and eliminate terms like mild, moderate, and severe. The changes come as new tests for detecting Alzheimer’s-related proteins become more available, and as new treatments require confirmation of disease pathology before use.

Dr. Clifford Jack of the Mayo Clinic, the lead author of the report sponsored by the Alzheimer’s Association and the National Institute of Aging, explained that the new system is designed to be more accurate and better reflect a person’s underlying disease. The goal is to offer personalized medicine by using specific biomarkers associated with different disease stages. Dr. Maria Carrillo, chief scientific officer for the Alzheimer’s Association, emphasized the importance of understanding these biomarkers at varying degrees in people with different stages of the disease.

The new diagnostic approach assigns patients a score of 1 to 7 based on the presence of abnormal disease biomarkers and the extent of cognitive changes. It also includes four biological stages labeled a, b, c, and d. For example, Stage 1a indicates completely asymptomatic individuals with abnormal biomarkers, marking the beginning of evidence of the disease. Stage 2 represents individuals with abnormal biomarkers and subtle changes in cognition or behavior. Stage 3 corresponds to the current presymptomatic stage known as mild cognitive impairment, while stages 4, 5, and 6 are equivalent to mild, moderate, and severe dementia.

In addition, the new scale includes a Stage 0 category for people who carry genes that guarantee the development of Alzheimer’s. This category includes individuals with Down Syndrome, as 75% of them develop Alzheimer’s in adulthood. Dr. Jack likened the new scale to cancer stages, emphasizing that there is no such thing as mild breast cancer. He also noted that while many conditions can cause dementia, not all dementia is Alzheimer’s disease.

These proposed guidelines are aimed at helping doctors in their clinical practice, particularly as they prepare to offer new treatments that can slow the course of the disease rather than just treat symptoms. The draft guidelines will undergo expert review and comment before being revised to reflect that input, according to a spokesperson for the Alzheimer’s Association.

Alzheimer’s disease is characterized by changes in the brain that lead to the gradual destruction of memory and thinking skills. These changes include the presence of amyloid beta plaques and neurofibrillary tangles, resulting in the loss of neurons and their connections. The previous guidelines, issued in 2018, were primarily for research use and relied on costly tests that were not commonly used in standard medical practice. The new guidelines take into account the increased availability of tests for Alzheimer’s proteins and the need for confirmation of disease pathology.

In conclusion, the introduction of a new rating scale for Alzheimer’s disease aims to improve diagnosis and better reflect the underlying disease. By using specific biomarkers and a numerical staging system, doctors can provide more personalized treatment options for patients. The proposed guidelines are open for review and comment before being finalized. These changes come at a crucial time as new treatments are being approved and require confirmation of disease pathology prior to use.