Croisile B, Auriacombe S, Etcharry-Bouyx F, Vercelletto M
Service de neuropsychologie, hôpital neurologique, 59 boulevard Pinel, Bron cedex, France.
Rev Neurol (Paris). 2012 Jun;168(6-7):471-82. doi: 10.1016/j.neurol.2011.11.007. Epub 2012 May 12.
Criteria for the clinical diagnosis of Alzheimer's disease (AD) were established in 1984, and they needed to be updated and revised, in vue of the scientific knowledge acquired over the last decades.
The National Institute on Aging (NIA) and the Alzheimer's Association (AA) sponsored a series of advisory round table meetings to establish a revision of diagnostic and research criteria for AD. The workgroups reviewed the biomarker, epidemiological, and neuropsychological evidence, and proposed conceptual frameworks as well as operational research criteria based on the prevailing scientific evidence to date.
Three preclinical stages of AD were proposed: asymptomatic amyloidosis, asymptomatic amyloidosis+neurodegeneration, amyloidosis+neurodegeneration+subtle cognitive decline. The preclinical workgroup developed recommendations to determine the factors, which best predict the risk of progression from normal cognition to mild cognitive impairment (MCI) and AD dementia. It is necessary to refine these models with longitudinal clinical research studies. The workgroups on MCI and AD dementia sought to ensure that the revised criteria would be flexible enough to be used by both general healthcare providers without access to neuropsychological testing, advanced imaging, and cerebrospinal fluid measures, and specialized investigators involved in research or in clinical trial studies who would have these tools available. The symptomatic predementia phase of AD was referred to as MCI due to AD. Core clinical and cognitive criteria of MCI were proposed, the final set of criteria for MCI due to AD has four levels of certainty, depending on the presence and nature of the biomarker findings. Criteria for all-cause dementia and for AD dementia were presented. Dementia caused by AD were classified in: probable AD dementia, possible AD dementia, and probable or possible AD dementia with evidence of the AD pathophysiological process, for use in research settings. The core clinical criteria for AD dementia will continue to be the cornerstone of the diagnosis in clinical practice, but biomarker evidence is expected to enhance the pathophysiological specificity of the diagnosis.
In the revised criteria, a conceptual distinction is made between AD pathophysiological processes and clinically observable syndromes. The core clinical criteria of the recommendations regarding MCI due to AD and AD dementia are intended to guide diagnosis in the clinical setting whereas the recommendations of the preclinical AD workgroup are intended purely for research purposes and do not have any clinical implications. Considerable work is needed to validate the criteria that use biomarkers and to standardize biomarker analysis for use in community settings.
阿尔茨海默病（AD）的临床诊断标准于1984年制定，鉴于过去几十年所获得的科学知识，这些标准需要更新和修订。
美国国立衰老研究所（NIA）和阿尔茨海默病协会（AA）主办了一系列咨询圆桌会议，以修订AD的诊断和研究标准。各工作组审查了生物标志物、流行病学和神经心理学证据，并根据目前的科学证据提出了概念框架以及操作性研究标准。
提出了AD的三个临床前期阶段：无症状淀粉样变性、无症状淀粉样变性+神经变性、淀粉样变性+神经变性+轻微认知衰退。临床前期工作组制定了相关建议，以确定最能预测从正常认知进展为轻度认知障碍（MCI）和AD痴呆风险的因素。有必要通过纵向临床研究对这些模型进行完善。MCI和AD痴呆工作组力求确保修订后的标准足够灵活，以便普通医疗服务提供者（他们无法进行神经心理学测试、高级成像和脑脊液检测）以及参与研究或临床试验研究且可使用这些工具的专业研究人员都能使用。AD的症状前痴呆阶段被称为AD所致的MCI。提出了MCI的核心临床和认知标准，AD所致MCI的最终标准集有四个确定程度级别，这取决于生物标志物结果的存在情况和性质。列出了全因性痴呆和AD痴呆的标准。AD所致痴呆分为：很可能的AD痴呆、可能的AD痴呆、有AD病理生理过程证据的很可能或可能的AD痴呆，用于研究环境。AD痴呆的核心临床标准将继续是临床实践中诊断的基石，但生物标志物证据有望提高诊断的病理生理特异性。
在修订后的标准中，对AD病理生理过程和临床可观察到的综合征进行了概念区分。关于AD所致MCI和AD痴呆的建议的核心临床标准旨在指导临床环境中的诊断，而临床前期AD工作组的建议纯粹用于研究目的，没有任何临床意义。需要开展大量工作来验证使用生物标志物的标准，并规范生物标志物分析以便在社区环境中使用。
