Centre des Maladies Cognitives et Comportementales, Institut du Cerveau et de la Moelle épinière, Paris, France; Université Pierre et Marie Curie-Paris 6, AP-HP, Hôpital de la Salpêtrière, Paris, France.
Division of Neurology, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada.
Lancet Neurol. 2014 Jun;13(6):614-29. doi: 10.1016/S1474-4422(14)70090-0.
In the past 8 years, both the International Working Group (IWG) and the US National Institute on Aging-Alzheimer's Association have contributed criteria for the diagnosis of Alzheimer's disease (AD) that better define clinical phenotypes and integrate biomarkers into the diagnostic process, covering the full staging of the disease. This Position Paper considers the strengths and limitations of the IWG research diagnostic criteria and proposes advances to improve the diagnostic framework. On the basis of these refinements, the diagnosis of AD can be simplified, requiring the presence of an appropriate clinical AD phenotype (typical or atypical) and a pathophysiological biomarker consistent with the presence of Alzheimer's pathology. We propose that downstream topographical biomarkers of the disease, such as volumetric MRI and fluorodeoxyglucose PET, might better serve in the measurement and monitoring of the course of disease. This paper also elaborates on the specific diagnostic criteria for atypical forms of AD, for mixed AD, and for the preclinical states of AD.
在过去的 8 年里，国际工作组（IWG）和美国国家老龄化研究所-阿尔茨海默病协会都为阿尔茨海默病（AD）的诊断制定了标准，这些标准更好地定义了临床表型，并将生物标志物纳入诊断过程，涵盖了疾病的整个分期。本立场文件考虑了 IWG 研究诊断标准的优势和局限性，并提出了改进诊断框架的建议。在此基础上，AD 的诊断可以简化，需要存在适当的临床 AD 表型（典型或非典型）和与阿尔茨海默病病理存在一致的病理生理学生物标志物。我们建议，疾病的下游拓扑生物标志物，如体积 MRI 和氟脱氧葡萄糖 PET，可以更好地用于疾病过程的测量和监测。本文还详细说明了非典型 AD、混合 AD 和 AD 临床前状态的具体诊断标准。
