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Impact of the IWG/Dubois Criteria for Alzheimer’s Disease in Imaging Studies

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PET and SPECT in Neurology

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Abstract

In 2007, an International Working Group (IWG) provided a new conceptual framework according to which AD moves from a clinicopathological entity to a clinico-biological entity (Dubois et al. 2007). The new IWG/Dubois criteria stipulate that AD can be recognized in vivo on the presence of two associated features. The first is the evidence of an “amnestic syndrome of the hippocampal type” at least in the typical form of the disease. The importance of a specific memory pattern was highlighted because none of the other cognitive changes, which can be encountered in AD even at a prodromal stage, are specific of the disease. The second necessary feature is supportive evidence from biomarkers that were proposed for the first time for the diagnosis of AD. The biomarkers of AD were divided into two groups: (1) the pathophysiological markers (these markers identify AD pathology since they are strongly correlated with postmortem AD histopathological changes, and they are considered as markers of diagnosis and mainly consist in positive PET amyloid scan results or CSF changes) and (2) topographical markers (they reflect downstream damage and are rather markers of progression, more targeted at assessing change over time and predicting outcomes). They mainly consist in hippocampal atrophy on volumetric MRI or hypometabolism on fluorodeoxyglucose [FDG]-PET. As a consequence, CSF and MRI investigations are no longer proposed for excluding other etiologies of brain dysfunction but are primarily used for detecting AD-related changes. The added value of biomarkers and therefore the specificity of the IWG/Dubois criteria for the diagnosis of AD were further confirmed.

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Authors and Affiliations

  1. Department of Neurology, Dementia Research Center (IM2A), ICM, INSERM UMR_975, Salpêtrière Hospital, University Pierre et Marie Curie Paris 6, Paris, France

    Bruno Dubois & Olga Uspenskaya

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  1. Bruno Dubois
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  2. Olga Uspenskaya
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Correspondence to Bruno Dubois .

Editor information

Editors and Affiliations

  1. Dept. of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A.J.O. Dierckx

  2. Faculty of Electrical Engineering and Information Technology, University of Applied Sciences Offenburg, Offenburg, Germany

    Andreas Otte

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Erik F.J. de Vries

  4. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Aren van Waarde

  5. Neurology, University Medical Center Groningen, Groningen, The Netherlands

    Klaus L. Leenders

Glossary

Alzheimer’s disease (AD) 

The whole clinical phase, no longer restricted to the dementia syndrome.

AD dementia

 When cognitive symptoms interfere with activity of daily living.

Alzheimer’s pathology

 Underlying neurobiological changes responsible for AD.

Asymptomatic at risk

 Cognitively normal individuals with positive pathophysiological biomarkers.

Atypical AD

 Less common but well-characterized clinical phenotypes that occur with Alzheimer’s pathology. The diagnosis of AD needs in vivo evidence of pathophysiological markers.

Mixed AD

 Patients who fulfill the criteria for AD and additionally present with clinical and biomarkers evidence of other comorbid disorders.

Mild cognitive impairment (MCI)

 Patients for whom there is no disease clearly identified.

Pathophysiological markers

 Biological changes that reflect the underlying AD pathology (CSF changes; PET amyloid). They are markers of diagnosis.

Presymptomatic AD

 Cognitively normal individuals with a proven AD autosomal dominant mutation.

Prodromal AD

 The early symptomatic, predementia phase of AD.

Topographical biomarkers

 Downstream markers of neurodegeneration that can be structural (MRI) or metabolic (FDG-PET). They are markers of progression.

Typical AD

 The most common clinical phenotype of AD, characterized by an amnestic syndrome of the hippocampal type.

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Dubois, B., Uspenskaya, O. (2014). Impact of the IWG/Dubois Criteria for Alzheimer’s Disease in Imaging Studies. In: Dierckx, R., Otte, A., de Vries, E., van Waarde, A., Leenders, K. (eds) PET and SPECT in Neurology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54307-4_13

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