From mild cognitive impairment to subjective cognitive decline: conceptual and methodological evolution.
From mild cognitive impairment to subjective cognitive decline: conceptual and methodological evolution.
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DOI：
10.2147/ndt.s123428
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发表时间：
2017
影响因子：
3.2
通讯作者：
Chiu MJ
中科院分区：
文献类型：
--
作者：
Cheng YW;Chen TF;Chiu MJ
在阿尔茨海默病（AD）的早期阶段识别受试者对于药物开发和可能的干预或预防认知衰退是至关重要的。轻度认知功能障碍（MCI）的概念在过去的二十年中逐渐发展，以定义处于正常衰老和痴呆之间的过渡阶段的受试者。来自横断面和纵向研究的证据表明，MCI与AD生物标志物阳性风险增加和AD年转换率增加5%-17%相关。MCI受试者中AD生物标志物的存在与进展为痴呆的风险更高相关。然而，早期在MCI受试者中进行的药物治疗临床试验令人失望。为了将AD的谱扩展到MCI之前的早期阶段，引入了主观认知下降（SCD），并将其定义为在通过认知测试检测到缺陷之前自我报告的认知下降。SCD受试者的基础AD病理风险增加。然而，SCD也可能继发于其他异质性病因，包括其他神经退行性疾病和精神疾病、人格特征、身体状况和药物使用。提出了几种临床和生物标志物特征来预测SCD受试者转化为AD的风险。需要进一步的纵向研究来支持这些高风险特征的有效性。
Identification of subjects at the early stages of Alzheimer’s disease (AD) is fundamental for drug development and possible intervention or prevention of cognitive decline. The concept of mild cognitive impairment (MCI) evolved during the past two decades to define subjects at the transitional stage between normal aging and dementia. Evidence from cross-sectional and longitudinal studies has shown that MCI is associated with an increased risk of positive AD biomarkers and an increased annual conversion rate of 5%–17% to AD. The presence of AD biomarkers in subjects with MCI was associated with an even higher risk of progression to dementia. However, earlier clinical trials for pharmacotherapy in subjects with MCI were disappointing. To extend the spectrum of AD to an earlier stage before MCI, subjective cognitive decline (SCD) was introduced and was defined as self-reported cognitive decline before the deficits could be detected by cognitive tests. Subjects with SCD have an increased risk of underlying AD pathology. However, SCD can also develop secondary to other heterogeneous etiologies, including other neurodegenerative and psychiatric diseases, personality traits, physical conditions, and medication use. Several clinical and biomarker features were proposed to predict risk of conversion to AD in subjects with SCD. Further longitudinal studies are needed to support the validity of these high-risk features.