Diagnosing Alzheimer's disease – how good is neuropathology?

Advances in clinical diagnostics, such as neuroimaging, as well as the development of new biomarkers, have raised questions as to whether neuropathological assessment is both accurate and specific enough to diagnose Alzheimer’s disease (AD).  Two articles published last week in Alzheimer’s Research & Therapy address this issue and make up a pro/con debate discussing whether neuropathology can confirm the exact diagnosis of AD.

Arguing the case for, Margaret Esiri stresses that neuropathology is still the gold standard by which to reach a reliable diagnosis of AD and suggests that because diseases change and evolve over time, only this tool is in a position to provide a concrete distinction between pathological processes.  Esiri acknowledges that novel clinical diagnostics will have a part to play in the future, but that until our understanding of AD improves neuropathology still has a future in elucidating the molecular and cellular mechanisms involved.

In his counter viewpoint, Kurt Jellinger argues that although neuropathology has provided us with a large amount of data on the pathogenesis and pathophysiology of AD, there are a number of drawbacks associated with it (such as a quantitative nature and the existence of co-existing confounding processes in aged brains) and we should increasingly be focusing on using harmonised techniques to improve the accuracy and reproducibility of AD diagnosis.  Only this, he stresses, will allow us to devise successful neuroprotective and treatment strategies for the future.

Alex Kroll – Senior Assistant Editor, Alzheimer’s Research & Therapy

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