New Alzheimer’s Diagnostic Scale, Like Cancer

Experts in Alzheimer’s disease are redefining the way doctors diagnose patients with this progressive brain disorder, which is the most common type of dementia. They propose a seven-point rating scale based on the patient’s cognitive and biological changes, recently revealed during an Alzheimer’s Association conference in Amsterdam. This numerical scale aims to assess the progression of the disease similarly to cancer diagnoses, avoiding terms such as “mild,” “moderate,” and “severe.”

The change in guidelines, replacing those issued in 2018, is largely due to the increasing availability of tests that detect key Alzheimer’s-related proteins, such as beta-amyloid in the blood, and the emergence of new treatments that require confirmation of the disease’s pathology before administration.

The new diagnostic system aims to be more accurate and better reflect the underlying disease in each individual, according to Dr. Clifford Jack from the Mayo Clinic in Rochester, Minnesota, the lead author of the report sponsored by the Alzheimer’s Association and the National Institute on Aging, part of the U.S. National Institutes of Health.

The proposed diagnostic approach would classify patients on a scale from 1 to 7, depending on the presence of abnormal biomarkers of the disease and the extent of cognitive changes. Additionally, four biological stages designated as a, b, c, and d are established. For example, Stage 1a would be when a person is completely asymptomatic but has abnormal biomarkers.

The change in guidelines comes at a time when doctors in the United States are preparing to identify and treat patients with Eisai and Biogen’s recently approved medication Leqembi, as well as Eli Lilly’s experimental drug donanemab, which is under FDA review.

Dr. Jack emphasizes that this new scale does not aim to replace cancer diagnosis but has taken its numerical approach as a reference to provide greater accuracy in Alzheimer’s diagnosis. He also notes that many other conditions can cause dementia, but not all are Alzheimer’s disease.

The proposed guidelines aim for doctors to use them in clinical practice, especially now that there are treatments that can slow down the disease’s progression instead of just treating the symptoms. The draft guidelines are open for review and comments from experts and will be subsequently modified to reflect this feedback, according to an Alzheimer’s Association spokesperson.

It is worth mentioning that the 2018 guidelines were intended for use in research and used existing technologies to detect Alzheimer’s proteins, such as brain PET scans and cerebrospinal fluid tests, which could only be obtained through lumbar puncture, limiting their application in standard medical practice due to their high cost.