阿尔茨海默病作为一种临床生物结构-国际工作组建议
Bruno Dubois1,2, Nicolas Villain1,3, Lon Schneider4
1Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP Sorbonne Université, Institute of Memory and Alzheimer's Disease, Paris, France.
JAMA neurology
|November 1, 2024
概括
阿尔茨海默病 (AD) 不应该仅仅基于认知正常个体的生物标志物来诊断. 相反,生物标志物阳性个体应该被视为患有阿尔茨海默病的风险,没有被诊断出患有该疾病.
科学领域:
- 神经学 神经学
- 生物标志物 生物标志物
- 神经退行性疾病 神经退行性疾病
背景情况:
- 最近的一项运动使用生物标志物纯粹从生物学上定义了阿尔茨海默病 (AD).
- 阿尔茨海默病协会 (AA) 修订的标准与这种生物定义保持一致.
- 对于AD的基于血液的生物标志物的临床应用,社会理解和翻译存在担忧.
研究的目的:
- 为了解决对AD的修订后的AA标准.
- 提出AD作为临床生物结构的替代定义,用于临床使用.
- 更新国际工作组 (IWG) 的建议,详细阐述风险和症状前状态.
主要方法:
- 在PubMed的文献搜索和参考列表.
- 搜索术语包括"生物标志物"",粉样蛋白"",tau"",神经退行"",临床前"",CSF"",PET"",血"和"阿尔茨海默病".
- 审查了2020年7月至2024年3月期间发表的文章.
主要成果:
- 修订后的AA标准允许在具有一个核心AD生物标志物的认知正常个体中诊断AD.
- 文献表明,大多数生物标志物阳性,认知正常的个体不会很快出现症状.
- 在只有一个生物标志物的认知正常个体中诊断AD会带来临床挑战.
结论:
- 诊断阿尔茨海默病 (AD) 应该整合临床和生物因素,而不仅仅依赖生物标志物.
- 生物标志物阳性但在认知上正常的个体应被归类为患AD的"有风险"个体.
- 对于那些生物标志物表明迫在眉的症状发展的人来说,建议扩展"症状前的AD"构造.
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