Dubois Bruno, Feldman Howard H, Jacova Claudia, Dekosky Steven T, Barberger-Gateau Pascale, Cummings Jeffrey, Delacourte André, Galasko Douglas, Gauthier Serge, Jicha Gregory, Meguro Kenichi, O'brien John, Pasquier Florence, Robert Philippe, Rossor Martin, Salloway Steven, Stern Yaakov, Visser Pieter J, Scheltens Philip
INSERM U610, Hôpital de la Salpêtrière, Paris, France.
Lancet Neurol. 2007 Aug;6(8):734-46. doi: 10.1016/S1474-4422(07)70178-3.
The NINCDS-ADRDA and the DSM-IV-TR criteria for Alzheimer's disease (AD) are the prevailing diagnostic standards in research; however, they have now fallen behind the unprecedented growth of scientific knowledge. Distinctive and reliable biomarkers of AD are now available through structural MRI, molecular neuroimaging with PET, and cerebrospinal fluid analyses. This progress provides the impetus for our proposal of revised diagnostic criteria for AD. Our framework was developed to capture both the earliest stages, before full-blown dementia, as well as the full spectrum of the illness. These new criteria are centred on a clinical core of early and significant episodic memory impairment. They stipulate that there must also be at least one or more abnormal biomarkers among structural neuroimaging with MRI, molecular neuroimaging with PET, and cerebrospinal fluid analysis of amyloid beta or tau proteins. The timeliness of these criteria is highlighted by the many drugs in development that are directed at changing pathogenesis, particularly at the production and clearance of amyloid beta as well as at the hyperphosphorylation state of tau. Validation studies in existing and prospective cohorts are needed to advance these criteria and optimise their sensitivity, specificity, and accuracy.
美国国立神经疾病与中风研究所-阿尔茨海默病及相关痴呆症协会（NINCDS-ADRDA）和《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）中关于阿尔茨海默病（AD）的诊断标准是目前研究中的主流诊断标准；然而，它们如今已落后于科学知识前所未有的增长速度。现在，通过结构磁共振成像（MRI）、正电子发射断层扫描（PET）分子神经成像以及脑脊液分析，可获得AD独特且可靠的生物标志物。这一进展为我们提出AD修订诊断标准提供了动力。我们制定的框架旨在涵盖疾病的各个阶段，包括在全面性痴呆出现之前的最早阶段以及整个疾病谱。这些新标准以早期和显著的情景记忆损害这一临床核心为中心。它们规定，在MRI结构神经成像、PET分子神经成像以及淀粉样β蛋白或tau蛋白的脑脊液分析中，还必须至少有一个或多个异常生物标志物。许多正在研发的旨在改变发病机制的药物，特别是针对淀粉样β蛋白的产生和清除以及tau蛋白的过度磷酸化状态的药物，凸显了这些标准的及时性。需要在现有队列和前瞻性队列中进行验证研究，以推进这些标准并优化其敏感性、特异性和准确性。
