INTRODUCTION This study leverages a large, diverse cohort to characterize ethnoracial differences in amyloid positron emission tomography (PET) positivity and identify social determinants of health (SDOHs) contributing to these differences.METHODS We assessed differences in amyloid PET positivity by ethnoracial group (Black, Latinx, or all other races/ethnicities [AORE]) among Medicare beneficiaries with cognitive impairment. Secondary analyses associated various SDOHs with amyloid PET positivity. RESULTS Among 5757 participants (21.7% Black, 20.3% Latinx, 58.1% AORE), we found lower odds of amyloid positivity in Black (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.62-0.83) and Latinx (OR: 0.78, 95% CI: 0.67-0.91) compared to AORE. Individuals in the comfortable (OR: 1.22, 95% CI: 1.05-1.42) and distressed (OR: 1.40, 95% CI: 1.08-1.82) Area Deprivation Index (ADI) groups had greater odds of amyloid positivity than individuals in the prosperous group. DISCUSSION Amyloid PET positivity rates were lower among Black and Latinx individuals and higher among individuals in more deprived ADI categories. This has potential implications for anti-amyloid therapies.

Abstract Advances in biomarker technology, digital cognitive assessments, and amyloid‐targeting therapies have redefined the opportunities for accurate and early diagnosis and care of Alzheimer's disease (AD). These advances also create new possibilities for intervention before the onset of cognitive impairment. This paradigm shift has increased the focus on Stages 1 and 2 of AD, in which individuals are cognitively unimpaired but exhibit biological evidence of disease. While early identification of AD offers an opportunity to intervene early to delay progression and preserve quality of life, it also presents complex challenges related to communicating diagnostic results to patients and their families, contextualizing the cost effectiveness of early diagnosis and treatment, and implementation of and equitable access to treatments. Recent, successfully enrolled, preclinical AD trials highlight the complex strategies required to identify asymptomatic, biomarker‐positive individuals on a large scale, and demonstrate critical knowledge gaps in inclusion, follow‐up, and long‐term outcome measurement. The Spring 2025 Alzheimer's Association Research Roundtable (AARR) meeting brought together academics, clinicians, industry, and regulatory leaders to exchange perspectives on current challenges, key learnings, and potential strategies for identifying and treating individuals in very early stages of AD, effectively and safely. This paper presents key takeaways from the Spring 2025 AARR meeting. Highlights New criteria for Alzheimer's disease (AD) enable early identification of AD pathology. Blood tests and digital cognitive assessment tools may facilitate early and personalized care. Plasma biomarkers may be scalable in clinical settings but need confirmation or follow‐up assessments in those individuals with equivocal results. Early therapy shows best results in people with lower initial amyloid and tau burden.

Amyloid PET use has been associated with change in clinical management among cognitively impaired older adults but various ethnoracial groups were underrepresented in prior studies. New IDEAS examined whether this association exists among cognitively impaired ethnoracially diverse Medicare beneficiaries and beneficiaries presenting with clinically “atypical” (non-memory predominant) presentations of Alzheimer's disease (AD). New IDEAS was a national, multi-site, prospective, longitudinal study that enrolled Medicare beneficiaries with mild cognitive impairment (MCI) or dementia who underwent amyloid PET scan as recommended by their treating dementia specialists at “real-world” clinics. The study examined association between amyloid PET and subsequent change in clinical management within 90 days of PET. Primary endpoint was change in management between pre- and post-PET visits defined as a composite inclusive of change in AD and non-AD drugs and change in counseling about safety and future planning. Proportions of change in management between pre- and post-PET visit by group are reported as well as logistic regression examining association between composite change in management and multiple factors. Median age of 4363 participants is 75 (range 35-98) years and 55.4% are female, 63.8% having MCI and 65.4% (95% CI 64.0, 66.8) amyloid PET positive. The sample includes 938 (21.5%) Black/African American, 707 (16.2%) Hispanic/Latino, and 2718 (62.3%) other individuals with 1330 (30.5%) participants with atypical presentations of AD (Table 1). Overall change in management occurred in 54.7% (95% CI 51.5, 57.9) of Black/African American, 53.7% (50.1, 57.4) of Hispanic/Latino, and 60.2% (58.3, 62.0) of other individuals. By clinical presentation, 44.1% (40.7, 47.6) of atypical clinical MCI, 52.6% (48.4, 56.7) of atypical dementia, 63.9% (61.8, 66.0) of typical MCI, and 59.9% (56.8, 62.8) of typical dementia participants had an overall change in management (Table 2). Logistic regression demonstrated significant interactions between Black/African American identity and positive amyloid PET scan (OR 1.64, 95% CI 1.14, 2.36; p 0.008) (Table 3). New IDEAS demonstrated that amyloid PET use among ethnoracially diverse Medicare beneficiaries and those with atypical and typical clinical presentations of AD leads to changes in clinical management, highlighting the value of this biomarker in a real-world clinical care setting.

The Alzheimer's Association and the Society of Nuclear Medicine and Molecular Imaging convened a multidisciplinary workgroup to update appropriate use criteria (AUC) for amyloid positron emission tomography (PET) and to develop AUC for tau PET. Methods: The workgroup identified key research questions that guided a systematic literature review on clinical amyloid/tau PET. Building on this review, the workgroup developed 17 clinical scenarios in which amyloid or tau PET may be considered. A modified Delphi approach was used to rate each scenario by consensus as "rarely appropriate," "uncertain," or "appropriate." Ratings were performed separately for amyloid and tau PET as stand-alone modalities. Results: For amyloid PET, 7 scenarios were rated as appropriate, 2 as uncertain, and 8 as rarely appropriate. For tau PET, 5 scenarios were rated as appropriate, 6 as uncertain, and 6 as rarely appropriate. Conclusion: AUC for amyloid and tau PET provide expert recommendations for clinical use of these technologies in the evolving landscape of diagnostics and therapeutics for Alzheimer's disease.

High cognitive reserve (CR) is associated with a reduced dementia risk. and better cognitive performance for given levels of Alzheimer's disease (AD) pathology. We hypothesized that CR is associated with baseline amyloid and tau pathology in the U . S . Study to P r o tect Brain Health through Lifestyle Inte rvention to R educe Risk (U.S.POINTER) Trial cohort. Participants were 60 to 79 years old, cognitively unimpaired, sedentary, did not follow a Mediterranean-DASH (MIND) diet, and had two or more other dementia risk factors. Of 2011 randomized, 52% consented to an ancillary imaging study that included amyloid and tau positron emission tomography (PET). Odds ratios (OR) and beta coefficients from logistic regression and linear regression models respectively were calculated to test whether higher EDU, an accepted CR measure, predicted lower risk of amyloid positivity, and lower entorhinal cortex (ERC) and meta-temporal region of interest (meta-ROI) tau standardized uptake value ratio (SUVR). Models were adjusted for age, sex, race/ethnicity, family history of dementia, APOE genotype, metabolic, dietary and physical fitness measures, and U.S.POINTER site. 911 U.S.POINTER imaging study participants had complete imaging data. Mean age was 68.4 ±5.24 years, 61.3% were female, 31.5% completed only high school (HS), 34.6% were college graduates (CG), 33.9% had advanced degrees (AdD) and 29.2% were amyloid positive on PET. Predictors of amyloid positivity included age (OR=1.09 1-year increment , 95% CI = .06,1.13, p  < .001), race-ethnicity (1.67 white vs black/AA , 95% CI=0.99-2.82, p  = .054; 2.31 other vs black/AA, 95% CI=1.10, 4.84, p  = .024), number of APOE e4 alleles (OR 1 copy =3.01, 95% CI=2.16, 4.19, p  < .001; OR 2 copies =10.66, 95% CI = 4.40, 25.82, p  < .001), and memory loss in mother (OR=1.47, 95% CI=1.06,2.04, p  = .020). Higher CR was significantly associated with lower ERC tau SUVR (Beta CG vs HS  = -.047±.02, p  = .038; Beta AdD vs HS  = -.068±.023, p  = .003). EDU was unrelated to amyloid status or meta-ROI tau. In the U.S.POINTER Cohort, higher CR predicted lower tau burden in the ERC, a brain area first affected by tau deposition. Meta-ROI tau may be too low in this cognitively unimpaired sample to reveal associations. The findings suggest a possible role of CR in conferring biological resistance to AD pathology.

INTRODUCTION:The New Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study (NCT04426539) evaluated the association between amyloid positron emission tomography (PET) and changes in clinical management among ethnoracially diverse, clinically heterogeneous patients. METHODS:We assessed diagnosis and management plan before and 90 ± 30 days after amyloid PET among Medicare beneficiaries who met 2018 National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment (MCI) or dementia. We aimed to identify ≥ 30% change in a composite patient management endpoint (CPME; i.e., changes in Alzheimer's disease [AD]/non-AD medications, changes in counseling). RESULTS:Among 5757 participants (median age 75 years; 21.7% Black, 20.3% Latinx, 58.1% all other races/ethnicities [AORE]), a change in CPME occurred in 59.0% (95% confidence interval 57.6%-60.5%) of individuals post PET. Change varied by ethnoracial identity and type of clinical presentation: Black (MCI: 55.3%, dementia: 55.8%), Latinx (MCI: 53.7%, dementia: 61.9%), AORE (MCI: 62.0%, dementia: 58.3%), typical (MCI: 64.8%, dementia: 60.9%), atypical (MCI 45.5%, dementia: 53.6%). DISCUSSION:Amyloid PET is associated with clinical management among diverse, clinically heterogeneous populations. HIGHLIGHTS:Changes in management plan occurred in 59% of patients 90 days after amyloid positron emission tomography. Rates of change in management exceeded the pre-specified goal of > 30% across ethnoracial groups. Rates of change in management also exceeded > 30% among amnestic and non-amnestic Alzheimer's disease presentations.

The design of clinical trials in Alzheimer's disease (AD) must consider the development of new plasma, cerebrospinal fluid (CSF), and imaging biomarkers. They must also define clinically meaningful outcomes for patients and set endpoints that measure these outcomes accurately. With the accelerated United States Food and Drug Administration (FDA) approval of the first anti-amyloid, disease-modifying treatment for AD, a monoclonal antibody called aducanumab, the landscape of clinical trial design is evolving. Enrolment in clinical trials may be impacted by the availability of this and other treatments, and trial design must take into consideration that patients may desire a disease-modifying treatment rather than potentially being randomized to the placebo arm. The Alzheimer's Association Research Roundtable (AARR) Fall 2021 meeting discussed the consideration of well-defined AD staging criteria in protocol design and how they influence more standardized inclusion/exclusion criteria for trials, as well as what constitutes meaningful differentiation between the stages. Discussion explored the current state of knowledge regarding biomarkers and how they can inform AD staging criteria, as many trials are now designed based on specific biomarker features, further underscoring the importance of coordinating AD staging criteria and biomarkers. The relationship between cognition and biomarkers has been studied and this must continue as trials move forward. Researchers, patients, clinicians, regulatory scientists, and payers discussed the state of the field as well as the future of symptomatic Alzheimer's disease clinical trials. Highlights:The Alzheimer's Association Research Roundtable (AARR) convened leaders from academia and industry as well as patients, care partners, clinicians, regulators, and payers to discuss the topic of operationalizing selection criteria for clinical trials and the role of biomarkers.Well-defined Alzheimer's disease (AD) staging criteria are an important consideration in study protocol design.Staging criteria and biomarkers must be coordinated to yield high-quality clinical trial results that have meaning for patients with AD by selecting a population most likely to benefit from a specific treatment.

A 24–30 Centiloid (CL) threshold was collectively considered by a group of global dementia experts as a practical and implementable cut-off for anti-amyloid therapy intervention, in Alzheimer's disease patients who have been diagnosed at the mild cognitive impairment or mild dementia stage of their disease. Though additional validation is needed, knowledge of this threshold would be valuable to those involved in diagnosing and treating patients in the new AD care pathways, as well as entry into clinical trials. Therapy monitoring to determine future treatment response and assess amyloid clearance can be accomplished with amyloid PET with some technical details still to be elucidated.

The Imaging Dementia—Evidence for Amyloid Scanning (IDEAS) study demonstrated that amyloid PET changes patient management in >60% of Medicare beneficiaries with MCI/atypical dementia. IDEAS had limited racial/ethnic diversity and excluded patients with “typical” amnestic clinical presentations. Here we present preliminary results from the New IDEAS study, which evaluates the clinical impact of amyloid PET in a more racially, ethnically and clinically diverse cohort. Launched in December 2020, the New IDEAS study (NCT04426539) is recruiting Medicare beneficiaries with typical (amnestic) and atypical (non-amnestic) MCI/dementia at 142 dementia specialty clinics across the U.S. Multifaceted, community-engaged and culturally-tailored strategies are implemented to enhance the diversity of the cohort. Based on self-identified race/ethnicity, patients are enrolled into 1 of 3 cohorts: Black/African-American (BAA), Latino/Hispanic (LAT), or not BAA or LAT (NBL, all other racial/ethnic identities). Patients undergo amyloid PET using an FDA-approved tracer with local visual read at 127 imaging facilities. Changes in management are measured between the pre-PET visit (intended management, assuming no access to amyloid PET) and 90-day post-PET visit (implemented management, incorporating amyloid PET results). A composite management endpoint captures changes in one or more of the following: AD drug therapy, non-AD drug therapy, counseling about safety and future planning. Out of 5,209 registered participants, 3,328 (63.9%) participants completed amyloid PET, pre- and post-PET visits at time of analysis (median age 74; 55.2% female; 22.6% BAA/17.5% LAT). Demographic and clinical features by cohort are shown in Table 1. Compared to NBL, BAA and LAT cohorts presented with greater clinical impairment, more frequent atypical clinical presentations and lower rates of amyloid PET positivity. Changes in the composite management endpoint occurred in 57.5% of all participants (57.2% MCI, 58.1% dementia), with similar rates across cohorts (Table 2). Following PET, anti-amyloid antibodies were newly recommended in 7.0% of BAA, 7.4% of LAT and 9.0% of NBL. Changes in management were more frequent in typical than atypical clinical presentations (Table 3). These preliminary findings highlight the clinical utility of amyloid PET in a diverse and representative sample of cognitively impaired patients recruited in real-world practice.

As Alzheimer's disease (AD) research advances, tau has emerged as both a critical biomarker and a promising therapeutic target, central to understanding disease mechanisms, tracking progression, and guiding treatment development. The Fall 2024 Alzheimer's Association Research Roundtable convened experts from academia, industry, National Institutes of Health (NIH), and the United States Food and Drug Administration (FDA) to explore current progress and future directions in tau-centered diagnostics and therapeutics. Discussions addressed the integration of tau biomarkers into the 2024 Revised Diagnostic Criteria for AD, updates to amyloid and tau positron emission tomography (PET) imaging, and modeling of biomarker trajectories. Presenters highlighted tau-targeting therapeutics including antisense oligonucleotides, monoclonal antibodies, and small molecules, alongside innovations in drug delivery. The interplay between anti-amyloid and anti-tau therapies and strategic design of combination trials were key themes. Regulatory insights facilitated discussions on drug approval pathways. The meeting highlighted the rapid evolution of tau research and emphasized opportunities to improve diagnostics, trial design, and treatment strategies in AD. Highlights:The Alzheimer's Association Research Roundtable (AARR) convened leaders from industry, academia, and government, to explore current progress and future directions in tau-centered diagnostics and therapeutics.Tau has emerged as both a critical biomarker and a promising therapeutic target, central to understanding disease mechanisms, tracking progression, and guiding treatment development.Discussions addressed the integration of tau biomarkers into the 2024 revised diagnostic criteria for AD, updates to amyloid and tau PET imaging, modeling of biomarker trajectories, tau-targeting therapeutics, and interplay between anti-amyloid and anti-tau therapies and strategic design of combination trials.

The Alzheimer's disease (AD) scientific field continues to make significant advances in early detection and treatments, which importantly rest on advances in our fundamental understanding of AD pathobiology and its contribution to cognitive decline. Clinical readouts of monoclonal antibodies against various forms of the amyloid beta (Aβ) protein indicate that the impact of these treatments may extend beyond reduction in amyloid plaques. The Alzheimer's Association Research Roundtable meeting held on May 17 and 18, 2022, reviewed our understanding to date of the impact of treatments targeting various species of Aβ; its impact on other related pathophysiology including tau; and ultimately, its effects on neurodegeneration and clinical decline, driven by the latest available data. Participants discussed the current evidence for a causal relationship among amyloid accumulation, tau alteration, and cognitive decline; the effect of anti-amyloid therapies on clinical and biomarker endpoints; and how we can accelerate the pathway to therapeutic approval and what should guide us for the near future. Highlights:The Alzheimer's Association Research Roundtable convened leaders from industry and academia, as well as patients, clinicians, and government and regulatory agency scientists to discuss the topic "Current Understanding of AD Pathophysiology & Impact of Amyloid-beta Targeted Treatments on Biomarkers and Clinical Endpoints."The totality of scientific evidence (clinical trials, animal data, modeling, and observational studies) on the relationship between amyloid beta (Aβ), amyloid, tau, and cognitive impairment is helping our understanding of the downstream effects and overall importance of lowering amyloid plaque load.Based on data from multiple phase 2 and 3 clinical trials of anti-amyloid monoclonal antibodies, there is strong evidence to support that a sufficiently large reduction in amyloid plaque load to near-normal levels is associated with positive changes in tau biomarkers and clinical endpoints.Reduction of Aβ plaque, measured easily by plasma amyloid biomarkers, is reasonably likely to predict benefit in clinical outcome measures.

Promising therapeutic interventions that target the underlying pathophysiology are changing the landscape of Alzheimer's disease (AD) research. The AD care pathway must be transformed to meet the challenge of bringing these new therapies to the increasing number of people living with AD within the existing healthcare framework. Challenges include identifying patients who may benefit from treatment interventions early in the course of the disease, ensuring that diagnostic tools are accessible and accurate, and developing capabilities to monitor the effectiveness of interventions over time. These challenges must be addressed at all levels, from primary care settings to tertiary treatment centers; this will require collaborative efforts between health systems, drug manufacturers, and research institutions to navigate this evolving landscape and ensure system readiness for patients and their families with AD. The Spring 2024 Alzheimer's Association Research Roundtable (AARR) meeting gathered industry representatives and clinicians to discuss insights, challenges, and solutions that will help researchers and health systems identify patients in the early stages of AD and deliver emerging therapies efficiently and safely. In this paper, we provide highlights from the Spring 2024 AARR meeting.

The Alzheimer's disease (AD) research field has entered a new era, where our fundamental understanding of the pathophysiology of AD and advances in biomarkers have not only allowed for earlier, timely, and accurate detection and diagnosis of the disease, but that amyloid removal has been shown to be associated with signals of slowing cognitive and functional decline. Although recent FDA-approved amyloid plaque-lowering monoclonal antibody therapies have shifted the trajectory of AD, additional treatment options will be key to further slowing clinical decline or stopping disease progression. Thus, new and emerging therapies for AD have created an evolving therapeutic landscape. The Alzheimer's Association Research Roundtable (AARR) Spring meeting held on May 23-34, 2023, brought together a broad array of scientific leaders from the AARR membership, academia, industry, and government and regulatory agencies to discuss the future of clinical trials in an era of regulator-approved amyloid-targeting therapies. Participants discussed lessons learned from other neurological diseases where disease-modifying treatments were first approved and key considerations for future clinical trials, for example, trial population real-world representativeness, duration, biomarker screening, efficacy endpoints, combination therapy, as well as overall trial design and the ethical and equity concerns that clinicians, patients, and their families face when considering clinical trial participation. Highlights:The Alzheimer's Association Research Roundtable (AARR) convened leaders from industry and academia, as well as patients, clinicians, and government and regulatory agency scientists to discuss the topic, "Alzheimer's Disease Drug Development in an Evolving Therapeutic Landscape."While recently approved amyloid-targeting therapies show great promise in providing clinically meaningful outcomes for patients and families, additional treatments, and a better understanding of dosing and administration of these approved treatments, are needed to further slow and eventually prevent clinical decline in AD.Approved therapies will impact many aspects of clinical trial design including the use of placebo-controls, participant re-enrollment, safety monitoring, as well as biomarker selection.This exciting new era in AD research represents a hopeful future for clinicians, patients, and their care partners.

The emergence of the United States Food and Drug Administration (FDA)-approved amyloid-targeting therapies for Alzheimer's disease challenges clinicians and healthcare providers with a transformative landscape. Effectively communicating the risks, benefits, burdens, costs, and available support associated with these novel disease-modifying treatments to patients, families, and other healthcare providers is essential but complex. In response, the Alzheimer's Association's Clinical Meaningfulness Workgroup has proposed language surrounding treatment eligibility, benefits, amyloid-related imaging abnormalities (ARIA), apolipoprotein E (APOE) genotyping, and treatment costs, serving as a resource to healthcare professionals in navigating discussions with patients and their families. As the landscape evolves with the approval of new Alzheimer's therapies, this resource stands poised for updates, ensuring its continued relevance in facilitating informed and meaningful patient-provider dialogues.

The Alzheimer's Disease Neuroimaging Initiative (ADNI) Private Partners Scientific Board (PPSB) Diversity, Equity, and Inclusion Working Group (DE&I WG) was established to work with the ADNI3 Diversity Task Force to provide an industry perspective on increasing the representation of diverse participants in ADNI3 and to build precompetitive cross-industry knowledge in engagement and recruitment of under-represented participants (URPs). In this article, we review and highlight the role and ongoing activities within the ADNI PPSB DE&I WG and provide a cross-industry perspective on areas where precompetitive collaboration can improve the inclusiveness in clinical trials, drawing on examples from ADNI4.

The newly proposed revised criteria for diagnosis and staging of Alzheimer's disease (AD) by the Alzheimer's Association (AA) Workgroup represent a significant milestone in the field. These criteria offer objective measures for diagnosing and staging biological AD, bridging the gap between research and clinical care. Although implementation feasibility may vary across regions and settings, improving the availability and accuracy of biomarkers, especially plasma biomarkers, is expected to enhance the applicability of these criteria in clinical practice. The Fall 2023 Alzheimer's Association Research Roundtable (AARR) meeting served as a forum for gathering industry perspectives and feedback on these revised criteria, ensuring that the new criteria inform research, clinical trial design, and clinical care. In this article, we outline a summary of the newly proposed "Revised Criteria for Diagnosis and Staging of AD: AA Workgroup" and provide highlights from the AARR meeting in fall 2023. Highlights:The Alzheimer's Association Research Roundtable (AARR) convened leaders from industry, academia, and government, to review the Revised Criteria for Diagnosis and Staging of AD: AA Workgroup, and gather industry perspectives and feedback on these revised criteria before its publication.The newly proposed revised criteria for diagnosis and staging of Alzheimer's disease (AD) by the AA's Workgroup represent a significant milestone, offering objective measures for the biological and staging of AD and bridging the gap between research and clinical care.Improving the availability and accuracy of biomarkers, especially blood-based biomarkers (BBMs) is expected to improve clinical research and enhance the applicability of these criteria in clinical practice.

The Alzheimer's disease (AD) research community continues to make great strides in expanding approaches for early detection and treatment of the disease, including recent advances in our understanding of fundamental AD pathophysiology beyond the classical targets: beta-amyloid and tau. Recent clinical trial readouts implicate a variety of non-amyloid/non-tau (NANT) approaches that show promise in slowing cognitive decline for people with AD. The Alzheimer's Association Research Roundtable (AARR) meeting held on December 13-14, 2022, reviewed the current state of NANT targets on underlying AD pathophysiology and their contribution to cognitive decline, the current data on a diverse range of NANT biomarkers and therapeutic targets, and the integration of NANT concepts in clinical trial designs. Participants also discussed the current definition of therapies that target underlying AD pathophysiology, what endpoints best define what is considered a meaningful change beyond the current approved definition for clinical efficacy, and how the recent NANT findings should inform the development of future guidelines for AD classification and personalized treatment strategies. Highlights:The Alzheimer's Association Research Roundtable (AARR) convened leaders from industry, academia, and government to review the current state of non-beta amyloid and non-tau (NANT) targets on underlying Alzheimer's disease (AD) pathophysiology.The totality of scientific and clinical evidence supports the hypothesis that emerging NANT targets play a role in cognitive decline and neurodegeneration in AD. New biomarkers based on NANT targets must be globally developed and implemented with specific consideration of fluid biomarkers as a cost-effective clinical option, to ensure better, more equitable treatment options for AD.

Abstract In this chapter we review recent research on authoritarianism with the goal of addressing major issues of conceptualization, measurement, and political consequences. We highlight a conceptualization of authoritarianism that identifies the desire for social cohesion and defense of ingroup norms as central to the dynamics of authoritarianism. The consequences of authoritarianism—intolerance of dissent, out-group animosity, and support for anti-democratic leaders and parties—are a result of the experience of threat to social cohesion among those with authoritarian predispositions. Threats may be associated with processes of social change (changing gender norms) or changes to the status of the majority group from immigration. There is also some evidence that those low in authoritarianism may respond to existential threats (terrorism) with support for increased security. The role of threat in the dynamics of authoritarianism helps to provide a basis for understanding the conditions under which authoritarianism becomes a politically potent force.

We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome.

Alzheimer's disease (AD) staging criteria lack standardized, empirical description. Well-defined AD staging criteria are an important consideration in protocol design, influencing a more standardized inclusion/exclusion criteria and defining what constitutes meaningful differentiation among the stages. However, many trials are being designed on the basis of biomarker features and the two need to be coordinated. The Alzheimer's Association Research Roundtable (AARR) Spring 2021 meeting discussed the implementation of preclinical AD staging criteria, and provided recommendations for how they may best be incorporated into clinical trials research. Discussion also included what currently available tools for global clinical trials may best define populations in preclinical AD trials, and if are we able to differentiate preclinical from clinical stages of the disease. Well-defined AD staging criteria are key to improving early detection, diagnostics, clinical trial enrollment, and identifying statistically significant clinical changes, and researchers discussed how emerging blood biomarkers may help with more efficient screening in preclinical stages.