I applaud the EMA for taking this, and the previous, initiative, since they clearly may boost industry to use these markers in future clinical trials. Further, both EMA guidelines clearly underline the rationale of the concept reflected in the Dubois set of criteria. I would concur with Paul Aisen that MR hippocampal atrophy is too much a downstream marker to be used in the very early stage for selecting (future) AD cases. Amyloid markers are better suited for this, and within the amyloid-positive individuals, MRI may indicate the patients who are already further on the path to clinical AD.

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