156| Updated Diagnosis and Staging Criteria for Alzheimer’s Disease – A Conversation with Dr. Cliff Jack and Dr. Kevin Duff
Dec 1, 2024
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In this engaging discussion, Dr. Kevin Duff, a board-certified clinical neuropsychologist and Alzheimer’s researcher, and Dr. Clifford Jack, a leading expert in Alzheimer’s biology from Mayo Clinic, explore the latest updates in diagnosing and staging Alzheimer’s disease. They delve into the complexities of combining biological markers with cognitive assessments, the predictive validity of amyloid PET scans in asymptomatic individuals, and the evolving criteria for effective patient care. Their insights may reshape how we understand and approach Alzheimer's diagnostics, offering hope for future advancements.
The podcast discusses the shift towards a biological definition of Alzheimer's disease emphasizing the importance of biomarkers over clinical symptoms.
Contrasting viewpoints among experts highlight the debate in the neuropsychology community regarding cognitive and behavioral aspects in diagnosing Alzheimer's.
There is a significant focus on the need for neuropsychologists to adapt their diagnostic approaches to include both biomarkers and clinical evaluations.
Deep dives
Biomarker-Based Definition of Alzheimer's Disease
The podcast discusses the advancement of a purely biological definition of Alzheimer's disease (AD) based on biomarkers such as amyloid PET scans and cerebrospinal fluid analysis. This new approach focuses on the underlying biology rather than solely on clinical symptoms, altering the traditional understanding of the disease. The recent publication by the National Institute on Aging and the Alzheimer's Association emphasizes detecting biological evidence of the disease years before clinical symptoms manifest, advocating for a continuum of the disease. This shift is aimed at improving the identification and diagnosis of AD, which is crucial given the disease's pervasive impact.
Diverse Perspectives Among Experts
The conversation highlights contrasting viewpoints between Dr. Clifford Jack, who supports the biological definition, and Dr. Kevin Duff, who presents a more skeptical stance. Their discussion reflects broader discussions within the neuropsychology community about the implications of this revised definition. Kevin shares insights from a survey of neuropsychologists, revealing a mix of reactions regarding the new criteria, signifying the ongoing debate on how AD should be classified. This divergence is crucial for understanding how different sectors in the field view the implications of biomarker-based diagnoses.
Importance of Cognition and Behavior
Listeners are informed about the challenge of balancing biological definitions of AD with the recognition of cognitive and behavioral aspects. The podcast emphasizes the importance of considering clinical symptoms, such as cognitive decline and neurobehavioral changes, when diagnosing AD. Kevin articulates a perspective that cognition and behavior should be integral to any definition of the disease due to their significant impact on patients' functioning. This discussion reveals the complexity of diagnosing AD and the necessity of considering both biological and symptomatic evidence.
Impact of Age and Symptom Onset
The dialogue addresses the role of age in the early detection and classification of AD, with Cliff emphasizing that disease processes can begin many years before symptoms appear. The notion that younger individuals with genetic predispositions might inevitably develop symptoms contrasts with the uncertainty surrounding older adults who may show biomarker positivity without clinical signs. This raises critical questions about how to approach treatment and diagnosis in different age groups. The ongoing debate highlights the need for a balanced understanding of both preclinical and symptomatic phases of the disease.
Clinical Implications for Neuropsychologists
The practical implications of the discussion for neuropsychologists are significant, especially regarding diagnosis and treatment recommendations. Cliff suggests that neuropsychologists should focus on extensively evaluating the underlying causes of cognitive impairment, while also considering biological markers if treatment is being pursued. This approach underlines the necessity for thorough assessments to differentiate between Alzheimer's disease and other conditions. Neuropsychologists are encouraged to use their clinical judgments in conjunction with any biomarker findings to provide better-informed treatment pathways.
Future Directions in Alzheimer's Research
The podcast concludes with reflections on the need for ongoing research and adaptation in the field of neuropsychology, especially concerning biomarkers and their clinical utility. Both experts express hope for advancements in blood-based biomarkers, which could significantly alter clinical practice and improve diagnostic accuracy. The conversation acknowledges the ongoing evolution of AD understanding, emphasizing the necessity for neuropsychologists to stay informed about scientific progress. This continual evolution is vital for ensuring that practitioners can provide the best care for their patients.
This episode is a conversation with Drs. Clifford Jack and Kevin Duff about recent updates to the diagnosis and staging of Alzheimer’s disease (AD). We discuss biological versus clinical/pathological approaches to diagnosing AD, analogies between AD and other medical conditions, the predictive validity of amyloid PET in asymptomatic older adults, the specific purpose of the recent Alzheimer's Association diagnosis and staging paper, the utility of currently available AD biomarkers, the status of blood-based biomarkers for AD, the amyloid hypothesis, concerns from neuropsychologists about the recent Alzheimer's Association biological definition of AD, and current state of the science for antiamyloid treatments in AD, among other topics.
Thanks for listening, and join us next time as we continue to navigate the brain and behavior!
[Note: This podcast and all linked content is intended for general educational purposes only and does not constitute the practice of psychology or any other professional healthcare advice and services. No professional relationship is formed between hosts and listeners. All content is to be used at listeners’ own risk. Users should always seek appropriate medical and psychological care from their licensed healthcare provider.]
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