The answer for question 4.9 is C. Karla, Debbie, Wang, Adimoolam, Alamo, Cynthia, Jorge got it right. In 2011, the National Institute of Aging and the Alzheimer’s Association (NIA–AA) published revised criteria for clinical diagnosis of Alzheimer disease. These updated the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS–ADRDA) criteria published in 1984 (“McKhann criteria”), which delineated 3 levels of diagnostic certainty: possible, probable, and definite. The 2011 revised criteria incorporated advances in clinical, laboratory, and imaging assessment that had emerged since 1984. Most notably, the new criteria incorporate biomarkers and formalize different stages of disease. The 2011 NIA–AA criteria have 3 classifications: probable Alzheimer disease, possible Alzheimer disease, and probable or possible Alzheimer disease with evidence of Alzheimer disease pathophysiologic process (biomarkers). This last classification is currently intended for use only in the research setting; the “probable” and “possible” diagnostic categories are intended for use in all clinical settings. The 2011 criteria do not include the diagnostic category of “definite” Alzheimer disease, which had required histopathologic evidence from biopsy or postmortem examination. The 2011 NIA–AA criteria do not require memory impairment for probable or possible Alzheimer disease. It has become clear that there are several non–memory-predominant presentations of Alzheimer disease, such as the syndrome of posterior cortical atrophy. The NIA–AA criteria require impairment in ≥2 cognitive domains for diagnosis of all-cause dementia, as well as probable and possible Alzheimer disease. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria continue to require memory impairment for diagnosis of dementia. The NIA–AA criteria formalize 3 distinct stages of Alzheimer disease: preclinical, defined almost entirely by biomarkers and currently intended for research use only; a symptomatic, predementia phase for mild cognitive impairment; and a dementia phase. The staging system explicitly acknowledges that cognitive function declines gradually across the spectrum of Alzheimer disease, and that there must be a significant degree of cognitive decline before daily activities can no longer be maintained. Preclinical Alzheimer disease (staging intended solely for research purposes at present) comprises 1) asymptomatic cerebral amyloidosis; 2) asymptomatic amyloid plus “downstream” degeneration; and 3) asymptomatic amyloidosis, neuronal injury, and subtle decline in cognition, behavior, or both. Genetic markers—whether for cause or susceptibility—are not included in the research criteria for preclinical Alzheimer disease. In the NIA–AA clinical criteria, probable Alzheimer disease can be diagnosed with an increased level of certainty if a causative genetic mutation (in APP, PSEN1, or PSEN2) is present. Presence of an APOE ɛ4 allele is considered not sufficiently specific to modify certainty levels of diagnosis. In the 2011 NIA–AA criteria, functional impairment continues to be required in the core clinical criteria for all-cause dementia, which must be satisfied before Alzheimer disease–spectrum diagnoses can be applied.
Posted on: Wed, 07 Aug 2013 00:54:59 +0000
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