Opposing views or like-minded? International Working Group and Alzheimer’s Association criteria

Category	Detail
Condition	Alzheimer’s disease
Key Mechanisms	Amyloid-β and tau proteinopathy identified via molecular biomarkers (PET scans, CSF, blood-based assays)
Target Population	Individuals with cognitive symptoms suspected of Alzheimer’s disease
Care Setting	Clinical dementia diagnostic work-ups

Both AA and IWG 2024 criteria mandate use of core Alzheimer’s biomarkers (amyloid and tau PET, CSF measures) for diagnosis.
AA and IWG differ in interpretation of biomarker positivity in cognitively unimpaired individuals: AA defines biomarker positivity as disease presence; IWG defines it as risk unless symptoms or deterministic progression markers are present.
Both criteria agree molecular biomarker testing should be limited to symptomatic individuals in clinical practice.

Use core biomarkers (amyloid and tau PET, CSF amyloid-β42 and phosphorylated tau) to establish Alzheimer’s disease diagnosis.
Blood-based biomarkers may be used when assays meet performance criteria or regulatory approval.
Do not use molecular biomarkers for diagnosis in cognitively unimpaired individuals without symptoms.

Incorporate biomarker testing in clinical diagnostic work-ups for symptomatic patients to improve diagnostic accuracy.

Further research needed with long-term follow-up of biomarker-positive cognitively unimpaired individuals to improve individualized risk prediction.

Risk of progression to symptoms varies by biomarker profile; advanced tau pathology with amyloid positivity confers near-deterministic risk.
Avoid labeling asymptomatic individuals with biomarker positivity as having disease unless risk is near-deterministic or symptoms present.

Symptomatic individuals undergoing dementia evaluation

Biomarker-supported diagnosis enables targeted disease management and potential use of disease-modifying therapies.

Restrict molecular biomarker testing to patients with cognitive symptoms.
Interpret biomarker results in context of clinical presentation and symptomatology.
Recognize that biomarker positivity alone in asymptomatic individuals indicates risk, not definitive disease (per IWG).
Use validated and regulatory-approved biomarker assays for clinical diagnosis.
Educate patients about the implications of biomarker findings and the current limits of predicting symptom progression.

Clinical Scorecard: Divergent Perspectives or Shared Insights? A Comparison of Alzheimer’s Association and International Working Group Diagnostic Criteria