不同诊断标准对阿尔茨海默病临床研究不同诊断标准的影响
Andrei Bieger1, Wagner S Brum1, Wyllians V Borelli1
1From the Graduate Program in Biological Sciences: Biochemistry (A.B., W.S.B., M.A.D.B., J.P.F.-S., D.O.S., E.R.Z.), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Wallenberg Centre for Molecular and Translational Medicine (M.S.), University of Gothenburg, Sweden; Pharmacology and Therapeutics Graduate Program (W.V.B.), Universidade Federal do Rio Grande do Sul (UFRGS); Memory Center (W.V.B.), Moinhos de Vento Hospital; Department of Anatomy (W.V.B.), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; The McGill University Research Centre for Studies in Aging (J.T., A.L.B., T.A.P., S.G., P.R.-N., E.R.Z.), McGill University; Douglas Research Institute (J.T., P.R.-N.), Le Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Ouest-de-l'Île-de-Montréal, McGill University; Departments of Neurology and Neurosurgery (J.T., S.G., P.R.-N.) and Psychiatry (J.T., S.G., P.R.-N.), McGill University, Montreal, Canada; Graduate Program in Biological Sciences: Pharmacology and Therapeutics (A.G.M., A.F.S.-S., E.R.Z.), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Department of Psychiatry and Neurochemistry (W.S.B., A.L.B., M.S., H.Z., K.B.), Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Sweden; Department of Neurology and Psychiatry (J.P.F.-S., T.A.P.), University of Pittsburgh, PA; Brain Institute of Rio Grande do Sul (J.C.D.C., L.P.S., E.R.Z.), Pontíficia Universidade Católica do Rio Grande do Sul; Department of Biochemistry (D.O.S.), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Neurology Service (R.M.C., A.F.S.-S., M.L.F.C.), Hospital de Clínicas de Porto Alegre; Department of Pharmacology (A.F.S.-S., E.R.Z.), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Department of Neurodegenerative Disease (M.S., H.Z.), Queen Square Institute of Neurology, University College London, United Kingdom; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Gothenburg, Sweden; UK Dementia Research Institute at University College London (H.Z.), United Kingdom; Hong Kong Center for Neurodegenerative Diseases (H.Z.).
阿尔茨海默病 (AD) 的诊断指南显示出显著的不一致性,超过42%的个人在标准上接受了不同的诊断. 需要更新指南,以便在AD研究中更好地分阶段和临床应用.
科学领域:
- 神经学和神经科学 神经学和神经科学
- 生物标志物和诊断方法
- 临床研究 临床研究
背景情况:
- 国家老龄化-阿尔茨海默病协会 (NIA-AA) 和国际工作组 (IWG) 最近更新的阿尔茨海默病 (AD) 诊断指南可能会改变临床诊断.
- 这些不断变化的标准需要评估它们对对认知障碍或没有认知障碍的个体进行分类的影响.
研究的目的:
- 评估不同阿尔茨海默病 (AD) 诊断指南 (2011 NIA-AA, 2016 IWG-2, 2018 NIA-AA, 2021 IWG-3) 对临床诊断的影响.
- 为了比较诊断标签频率,收度,生物标志物概况和这些指南中的预后价值,在认知不受损 (CU) 和认知受损 (CI) 个体的队列中.
主要方法:
- 利用来自阿尔茨海默病神经成像计划 (ADNI) 队列的临床和生物标记数据.
- 应用算法来分类1,195个人使用四个不同的AD诊断指南框架.
- 对比诊断标签 (不是AD,AD风险增加,AD) 的频率,一致性,生物标志物概况,以及预测认知衰退的预后价值.
主要成果:
- 观察到显著的诊断不一致,有42.8%的参与者在指导方针中获得了不同的标签,特别是在具有单个阳性生物标志物 (粉样或) 的生物标志物中.
- 被归类为AD的个体比例从33.6% (2016年IWG-2) 到50.0% (2018年NIA-AA) 不同.
- 大多数指南 (除2018年NIA-AA外) 成功预测了被归类为"阿尔茨海默病风险增加" (irAD) 个人认知障碍风险.
结论:
- 目前的阿尔茨海默病 (AD) 诊断标准显示出大量的不一致性,影响了分类和潜在的临床管理.
- 这些发现强调需要更新诊断标准,改进分期指标,以更好地告知临床实践,研究和治疗开发.
- 预后值的差异凸显了指导方针如何识别有认知能力下降风险的个体的变化.
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