The National Institute on Aging and the Alzheimer’s Association charged a workgroup with the task of revising the 1984 criteria for Alzheimer’s disease (AD) dementia. The workgroup sought to ensure that the revised criteria would be flexible enough to be used by both general healthcare providers without access to neuropsychological testing, advanced imaging, and cerebrospinal fluid measures, and specialized investigators involved in research or in clinical trial studies who would have these tools available. We present criteria for all-cause dementia and for AD dementia. We retained the general framework of probable AD dementia from the 1984 criteria. On the basis of the past 27 years of experience, we made several changes in the clinical criteria for the diagnosis. We also retained the term possible AD dementia, but redefined it in a manner more focused than before. Bio-marker evidence was also integrated into the diagnostic formulations for probable and possible AD dementia for use in research settings. The core clinical criteria for AD dementia will continue to be the cornerstone of the diagnosis in clinical practice, but biomarker evidence is expected to enhance the pathophysiological specificity of the diagnosis of AD dementia. Much work lies ahead for validating the biomarker diagnosis of AD dementia.

Cognition is 1 of 4 domains measured by the NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIH-TB), and complements modules testing motor function, sensation, and emotion. On the basis of expert panels, the cognition subdomains identified as most important for health, success in school and work, and independence in daily functioning were Executive Function, Episodic Memory, Language, Processing Speed, Working Memory, and Attention. Seven measures were designed to tap constructs within these subdomains. The instruments were validated in English, in a sample of 476 participants ranging in age from 3 to 85 years, with representation from both sexes, 3 racial/ethnic categories, and 3 levels of education. This report describes the development of the Cognition Battery and presents results on test-retest reliability, age effects on performance, and convergent and discriminant construct validity. The NIH-TB Cognition Battery is intended to serve as a brief, convenient set of measures to supplement other outcome measures in epidemiologic and longitudinal research and clinical trials. With a computerized format and national standardization, this battery will provide a "common currency" among researchers for comparisons across a wide range of studies and populations. Neurology Cognition is 1 of the 4 domains of behavioral and neurologic health assessed in the NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIH-TB). All domain measures were intended to be freely accessible, to be usable with individuals from 3 to 85 years of age, with each domain battery not to exceed 30 minutes in duration. Expert surveys were conducted and panels of research scientists and clinicians consulted in an iterative manner to rank cognitive subdomains in order of their perceived importance for health. Information was requested from experts (N 5 102) who reported sufficient familiarity with cognition to make recommendations for specific subdomains of importance. The 2 top-ranked subdomains were Executive Function (EF) (95%) and Episodic Memory (93%), followed by Language (55%), Processing Speed (52%), and Attention (50%). Many (57%) also listed a "Global Score" as important. Other cognitive subdomains were excluded because of lower priority in the rankings, coupled with the stringent time constraints on the length of the battery.The rationale for specific cognitive constructs within subdomains and instrument selection was based on a systematic review of the literature, including evidence of the known biological associations of each. The EF subdomain was deemed to include several distinct constructs, including Switching/Set Shifting, Inhibitory Control and Attention, and Working Memory. Because of

The data suggest that engagement in leisure activities may reduce the risk of incident dementia, possibly by providing a reserve that delays the onset of clinical manifestations of the disease.

Objective-To examine incidence rates and antecedents of MCI and AD among diverse elders without dementia at the initial visit. To examine the characteristics of elders with MCI who reverted to normal on follow-up. Methods-2364Caribbean Hispanics, African Americans, or non-Hispanic Whites, age 65 or older, free of dementia at initial evaluation and followed every 18 to 24 months. Incidence rate of MCI and AD was determined by examination of neurological, medical, psychiatric, and neuropsychological function.Results-Over 10,517 personyears, 21% of normal elders progressed to MCI (annual incidence rate = 5.1%, 95% CI = 4.6%-5.6%). Of those with MCI initially, 21.8% were subsequently diagnosed with AD (annual incidence rate = 5.4%; 95% CI = 4.7%-6.3%), 47% remained unchanged, and 31% reverted to normal. Those with MCI were 2.8 times more likely to develop AD than normal elders. MCI with impairment in memory and at least one other cognitive domain was associated with highest risk of progression to AD and was also least likely to revert to normal at follow-up. Consistent diagnosis of MCI, or incident probable or possible AD was 60% sensitive and 94% specific for the pathological diagnosis of AD.Interpretation-Impaired memory and language were useful predictors of transition to AD. Reversion to normal from MCI was frequent, but those with impairment in more than one cognitive domain were more likely to progress or remain impaired than those with single domain impairment. Clinical diagnosis of MCI does not always predict AD neuropathology.

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The current study sought to determine if discrepancies in quality of education could explain differences in cognitive test scores between African American and White elders matched on years of education. A comprehensive neuropsychological battery was administered to a sample of African American and non-Hispanic White participants in an epidemiological study of normal aging and dementia in the Northern Manhattan community. All participants were diagnosed as nondemented by a neurologist, and had no history of Parkinson's disease, stroke, mental illness, or head injury. The Reading Recognition subtest from the Wide Range Achievement Test–Version 3 was used as an estimate of quality of education. A MANOVA revealed that African American elders obtained significantly lower scores than Whites on measures of word list learning and memory, figure memory, abstract reasoning, fluency, and visuospatial skill even though the groups were matched on years of education. However, after adjusting the scores for WRAT–3 reading score, the overall effect of race was greatly reduced and racial differences on all tests (except category fluency and a drawing measure) became nonsignificant. These findings suggest that years of education is an inadequate measure of the educational experience among multicultural elders, and that adjusting for quality of education may improve the specificity of certain neuropsychological measures. (JINS, 2002, 8, 341–348.)

Mild cognitively impaired patients with memory plus other cognitive domain deficits, rather than those with pure amnestic MCI, constituted the high-risk group. Deficits in verbal memory and psychomotor speed/executive function abilities strongly predicted conversion to AD.

Alzheimer's disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross‐PIA white paper that provides both a concise “state‐of‐the‐science” report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations.