A paradigm of the diagnosis and treatment for the whole process of Alzheimer's disease.

INTRODUCTION: The clinical management of Alzheimer's disease (AD) is still constrained by the fact that its incompletely understood pathogenesis, difficulty in early diagnosis and the limited long-term treatment benefits so far. This article summarizes a regional perspective on the diagnosis and treatment of AD from the Alzheimer's Disease Chinese (ADC) guideline working group, aiming to improve the whole-process management of AD. DISCUSSION: The article presents a comprehensive overview of a proposed diagnostic and therapeutic paradigm for AD, consisting of a three-dimensional diagnostic framework and a sequential therapy concept. Crucially, while biological biomarkers of AD are present at all stages, they may be unrelated to clinical severity. To address this, the diagnostic framework combines core clinical criteria with early-changing biomarkers, syndrome staging and traditional Chinese medicine (TCM)-based pattern phenotyping. This integrated, simplified and practical approach enhances diagnostic certainty and its correlation with clinical severity. This sequential therapy is a stage-adaptive treatment plan adjusted according to the disease progression, utilizing a dynamic, multi-target combination therapy. Unlike the existing unchanging single-target therapies, this approach provides specific mechanistic interventions tailored to each stage to prolong efficacy and delay disease progression. CONCLUSIONS: This paradigm provides a whole-process, stage-oriented approach to AD diagnosis and management that may improve translational relevance, clinical applicability and continuity of care in real-world settings. Future cohort-based validation studies are needed to confirm its diagnostic performance and clinical benefits, and to refine its implementation. The onset and progression of AD symptoms follow a certain chronological order. The clinical diagnosis of AD should start with the symptoms, and the core clinical criteria must be met first. If an abnormal AD-specific biomarker result is present, it can increase the certainty of the clinical diagnosis of AD.AD biomarkers are present at all stages of the disease, but they may not be related to clinical severity. The evolution of syndromes at different stages of AD reflects the severity of clinical progression, and the syndrome-based staging should be incorporated into the clinical diagnostic framework of AD to address the clinical needs at different stages.From the perspective of disciplines, AD presents different TCM pattern phenotypes at different stages. Identifying these pattern phenotypes is not only part of the clinical diagnosis of AD, but also forms the basis for individualized treatment strategies.