区分与艾滋病相关的神经认知障碍和阿尔茨海默病:老年神经艾滋病领域的一个新问题。
Differentiating HIV-Associated Neurocognitive Disorders From Alzheimer's Disease: an Emerging Issue in Geriatric NeuroHIV.
作者信息
Milanini Benedetta, Valcour Victor
机构信息
Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
出版信息
Curr HIV/AIDS Rep. 2017 Aug;14(4):123-132. doi: 10.1007/s11904-017-0361-0.
PURPOSE OF REVIEW
The purpose of this review was to examine characteristics that may distinguish HIV-associated neurocognitive disorder (HAND) from early Alzheimer's disease (AD).
RECENT FINDINGS
Cerebrospinal fluid (CSF) AD biomarkers are perturbed in HIV, yet these alterations may be limited to settings of advanced dementia or unsuppressed plasma HIV RNA. Neuropsychological testing will require extensive batteries to maximize utility. Structural imaging is limited for early AD detection in the setting of HIV, but proper studies are absent. While positron-emission tomography (PET) amyloid imaging has altered the landscape of differential diagnosis for age-associated neurodegenerative disorders, costs are prohibitive. Risk for delayed AD diagnosis in the aging HIV-infected population is now among the most pressing issues in geriatric neuroHIV. While clinical, imaging, and biomarker characterizations of AD are extensively defined, fewer data define characteristics of HIV-associated neurocognitive disorder in the setting of suppressed plasma HIV RNA. Data needed to inform the phenotype of AD in the setting of HIV are equally few.
综述目的
本综述旨在研究可能区分HIV相关神经认知障碍(HAND)与早期阿尔茨海默病(AD)的特征。
最新发现
脑脊液(CSF)AD生物标志物在HIV患者中受到干扰,但这些改变可能仅限于晚期痴呆或血浆HIV RNA未得到抑制的情况。神经心理学测试需要广泛的测试组合以实现效用最大化。在HIV背景下,结构成像对于早期AD检测的作用有限,但缺乏相关的恰当研究。虽然正电子发射断层扫描(PET)淀粉样蛋白成像改变了年龄相关神经退行性疾病的鉴别诊断格局,但成本过高。在老年HIV感染者中,延迟AD诊断的风险现在是老年神经HIV领域最紧迫的问题之一。虽然AD的临床、影像学和生物标志物特征已得到广泛定义,但在血浆HIV RNA受到抑制的情况下,关于HIV相关神经认知障碍特征的数据较少。在HIV背景下用于明确AD表型所需的数据同样很少。