How early can we diagnose Alzheimer disease (and is it sufficient)? The 2017 Wartenberg lecture.
How early can we diagnose Alzheimer disease (and is it sufficient)? The 2017 Wartenberg lecture.
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DOI：
10.1212/wnl.0000000000006088
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发表时间：
2018-08-28
期刊：
影响因子：
9.9
通讯作者：
Petersen RC
中科院分区：
文献类型：
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作者：
Petersen RC
我们对诊断阿尔茨海默病 (AD) 的能力的理解正在发生巨大转变。在过去的几十年里，AD 一直是一种临床病理诊断，这种疾病的概念化很好地服务于该领域。通常，临床医生会识别出轻度认知障碍或痴呆等综合征，并将这种情况标记为“可能的 AD”，因为只有在尸检发现存在淀粉样蛋白斑和基于 tau 的神经原纤维缠结之前，才能做出明确的 AD 诊断。然而，随着包括神经影像学和脑脊液在内的 AD 生物标志物的出现，AD 病理学的识别可以在生活中进行，这极大地增强了临床医生准确了解临床综合征的潜在病因的能力。病理要素和临床症状之间时间关系的假设模型已经被提出，并对该领域产生了巨大影响。这使得临床医生能够具体了解特定临床综合征的根本原因。因此，临床医生的诊断能力正在不断发展。然而，AD 病理学只是描述衰老过程中认知变化原因的谜题的一部分。最常见的是，有多种病理实体有助于对衰老过程中认知变化的神经病理学解释。 AD 的变化为诊断提供了重要的因素，但最终的答案更为复杂。衰老和痴呆领域必须纳入这些额外的要素。
A seismic shift in our understanding of the ability to diagnose Alzheimer disease (AD) is occurring. For the last several decades, AD has been a clinical–pathologic diagnosis, and this conceptualization of the disease has served the field well. Typically, the clinician would identify a syndrome such as mild cognitive impairment or dementia, and label the condition as “probable AD” since the diagnosis of definite AD could not be made until an autopsy revealed the presence of amyloid plaques and tau-based neurofibrillary tangles. However, with the advent of biomarkers for AD including neuroimaging and CSF, the identification of AD pathology can be made in life, which greatly enhances the ability of clinicians to be precise about the underlying etiology of a clinical syndrome. Hypothetical models of the temporal relation among the pathologic elements and the clinical symptoms have been proposed and have influenced the field enormously. This has enabled clinicians to be specific about the underlying cause of a given clinical syndrome. As such, the diagnostic capability of the clinician is evolving. However, AD pathology is only a component of the puzzle describing the causes of cognitive changes in aging. Most often, there is a multitude of pathologic entities contributing to the neuropathologic explanation of cognitive changes in aging. AD changes contribute important elements to the diagnosis, but the final answer is more complex. The field of aging and dementia will have to incorporate these additional elements.