The natural history of Alzheimer´s disease (AD) refers to its progression in the absence of treatment, while prognosis, which may be used to weigh the benefits of different treatment options, refers to the likely outcome at specific points in the disease course. This slide deck discusses in detail the course, natural history and prognosis of AD, with illustrations.

This slide deck has been developed by Joseph Therriault, PhD, McGill University, Montréal, Québec, Canada; and Professor Serge Gauthier, McGill University, Montréal, Québec, Canada, in collaboration with Cambridge Medical – A Prime Global agency.

Index for
slide deck

Introduction

AD - Course, natural history and prognosis - Slide1
Course, natural history and prognosis
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AD - Course, natural history and prognosis - Slide2
Course, natural history, prognosis and their clinical significance

References:
1.APA Dictionary of Psychology Webpage. Disease course. Available at: https://dictionary.apa.org/disease-course. Accessed August 2023.

2.CDC Introduction to Epidemiology Webpage. Available at: https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section9.html. Ac…

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AD - Course, natural history and prognosis - Slide4
The typical course of Alzheimer’s disease

The ‘preclinical’ stage precedes mild cognitive impairment (MCI) and includes individuals who have evidence of early AD pathological changes, but do not meet clinical criteria for MCI or dementia.7 Three stages of preclinical AD were first defined in 2011.7 In Stage 1, i…

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AD - Course, natural history and prognosis - Slide6
New clinical staging of Alzheimer’s disease

Disease stage can be based on aetiology, clinical history, anatomical distribution of pathology, or biological features.3 Clinically determined stages to categorize AD lack specificity, however they do provide prognostically relevant information.3 Numerical clinical stag…

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AD - Course, natural history and prognosis - Slide7
Characterizing the progression of cognitive impairment

The severity of cognitive impairment in patients with AD varies.1 Clinical diagnosis of cognitive impairment in individuals is important for the overall care of the individual.1 There has been improvement in the level of awareness of dementia in primary care and speciali…

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AD - Course, natural history and prognosis - Slide9
The symptoms throughout the Alzheimer’s disease

The symptoms of AD can be generally divided into three categories – cognitive, functional, and neuropsychiatric. Cognitive symptoms in AD include memory, language, attention and executive functions, visuospatial skills and praxis (processing).2 These impairments can mani…

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AD - Course, natural history and prognosis - Slide10
Biological staging of Alzheimer’s disease

Development of the National Institute on Aging (NIA)–Alzheimer’s Association (AA) research framework system for staging was designed to stage two types of information independently from each other – disease severity using biomarkers, and the severity of cognitive impairm…

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AD - Course, natural history and prognosis - Slide11
Phases of Aβ buildup in Alzheimer’s disease brain

In vivo neuroimaging data from neuropathological studies show a spatiotemporal development of Aβ deposits in the brain, which originates in the cerebral regions and spreads from the neocortex, to the allocortex, to the brainstem, finally reaching the cerebellum.1,2 Aβ ag…

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AD - Course, natural history and prognosis - Slide12
Braak's neurofibrillary pathology correlates with cognitive impairment

The staging method developed by Braak and Braak suggests that the neurofibrillary pathology of AD progresses in a relatively predictable sequence across the medial temporal lobe structures, subcortical nuclei, and neocortical areas of the brain in seven stages, with the …

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AD - Course, natural history and prognosis - Slide13
Hypothetical biomarker model of Alzheimer’s disease pathophysiology

The time-course of biomarker abnormalities and the point at which they become detectable can help determine the primary cause of AD progression.3 The A/T/N biomarker classification system for AD includes three main classes of biomarkers – Ab, tau, and neurodegeneration –…

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