When is Alzheimers not dementiauCochrane commentary on The National Institute on Ageing and Alzheimers Association Research Framework for Alzheimers Disease

Early 2018 saw the release of new diagnostic guidance on Alzheimers disease from the National Institute on Ageing and the Alzheimers Association (NIA-AA). This proposed research framework represents a fundamental change in how we think about Alzheimers disease, moving from diagnosis based on clinical features to diagnosis based solely on biomarkers. These recommendations are contentious and have important implications for patients, clinicians, policy makers and the pharmaceutical industry. In this commentary, we offer a summary of the NIA-AA research framework. We then focus on five key areas: divorcing neuropathology from the clinical syndrome; the emphasis placed on one dementia subtype; validity of available biomarkers; the changing meaning of the term Alzheimers disease; and the potential for a research framework to influence clinical practice.