New insights into atypical Alzheimer's disease in the era of biomarkers.
New insights into atypical Alzheimer's disease in the era of biomarkers.
复制标题
生物标志物时代对非典型阿尔茨海默病的新见解。
DOI：
10.1016/s1474-4422(20)30440-3
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Murray ME
中科院分区：
文献类型：
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作者：
Graff-Radford J;Yong KXX;Apostolova LG;Bouwman FH;Carrillo M;Dickerson BC;Rabinovici GD;Schott JM;Jones DT;Murray ME
大多数阿尔茨海默病（AD）患者存在遗忘问题，但有相当大比例的患者（在阿尔茨海默病发作病例中过度代表）具有非典型表型，包括主要的视觉、语言、执行、行为或运动功能障碍。在过去，这些个体通常被诊断为晚期;然而，AD病理学的CSF和PET生物标志物的可用性以及将非典型形式的AD纳入新的诊断标准越来越多地使他们能够在疾病的早期更有信心地诊断。这反过来又使患者能够获得量身定制的信息，适当的护理和支持以及个性化的治疗计划。这些进展将提供更好的临床试验，这往往排除非典型表型。对非典型AD的研究揭示了AD谱中以前未认识到的神经病理异质性。神经影像学、遗传学、生物标志物和基础科学研究为可能导致不同大脑网络选择性脆弱性的因素提供了重要见解，对理解典型的迟发性AD具有潜在的机制意义。
Most patients with Alzheimer’s disease (AD) present with amnestic problems, but a significant proportion, over-represented in young-onset cases, have atypical phenotypes including predominant visual, language, executive, behavioural, or motor dysfunction. In the past, these individuals were often diagnosed late; however, availability of CSF and PET biomarkers of AD pathologies and incorporation of atypical forms of AD into new diagnostic criteria increasingly allows them to be more confidently diagnosed early in their illness. This in turn allows patients to be offered tailored information, appropriate care and support, and individualized treatment plans. These advances will provide improved access to clinical trials, which often exclude atypical phenotypes. Research into atypical AD has revealed previously unrecognised neuropathologic heterogeneity across the AD spectrum. Neuroimaging, genetic, biomarker, and basic science studies are providing important insights into the factors that may drive selective vulnerability of differing brain networks, with potential mechanistic implications for understanding typical late-onset AD.