Andreasen Niels, Blennow Kaj
Karolinska Institutet, Department of NEUROTEC, Section of Geriatric Medicine, M51, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
Clin Neurol Neurosurg. 2005 Apr;107(3):165-73. doi: 10.1016/j.clineuro.2004.10.011.
A correct clinical diagnosis, early in the course of Alzheimer's disease (AD), is of importance given the currently available symptomatic treatment with acetylcholine esterase inhibitors. The development of disease-modifying drugs like beta-sheet breakers or gamma- and beta-secretase inhibitors, emphasizes the need of improved diagnostic accuracy, especially in patients with mild cognitive impairment (MCI) that have incipient AD. Therefore, diagnostic markers in the cerebrospinal fluid (CSF) have become a rapidly growing research field. Three cerebrospinal fluid biomarkers (the 42 amino acid form of beta-amyloid (A beta), total tau, and phospho tau) have been evaluated in numerous scientific papers. These CSF markers have high sensitivity to differentiate early and incipient AD from normal aging, depression, alcohol dementia and Parkinson's disease, but lower specificity against other dementias, such as frontotemporal and Lewy body dementia. If these biomarkers are used in combination with a careful medical history, clinical examination, standard laboratory tests and imaging techniques of the brain, the diagnostic accuracy may be appropriate for the clinical evaluation of MCI cases.
鉴于目前可用的乙酰胆碱酯酶抑制剂对症治疗方法，在阿尔茨海默病（AD）病程早期做出正确的临床诊断至关重要。诸如β-折叠破坏剂或γ-和β-分泌酶抑制剂等疾病修饰药物的研发，凸显了提高诊断准确性的必要性，尤其是在患有早期AD的轻度认知障碍（MCI）患者中。因此，脑脊液（CSF）中的诊断标志物已成为一个快速发展的研究领域。众多科学论文对三种脑脊液生物标志物（42个氨基酸形式的β-淀粉样蛋白（Aβ）、总tau蛋白和磷酸化tau蛋白）进行了评估。这些脑脊液标志物在区分早期和初发AD与正常衰老、抑郁症、酒精性痴呆和帕金森病方面具有较高的敏感性，但针对其他痴呆症，如额颞叶痴呆和路易体痴呆，其特异性较低。如果将这些生物标志物与详细的病史、临床检查、标准实验室检查以及脑部成像技术结合使用，诊断准确性可能适用于MCI病例的临床评估。
