Teipel Stefan, Kilimann Ingo, Thyrian Jochen R, Kloppel Stefan, Hoffmann Wolfgang
Department of Psychosomatic Medicine, University Medicine Rostock, Rostock. Germany.
German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald. Germany.
Curr Alzheimer Res. 2018;15(1):18-27. doi: 10.2174/1567205014666170908093846.
The use of imaging markers for the diagnosis of predementia and early dementia stages of Alzheimer's disease (AD) has widely been explored in research settings and specialized care. The use of these markers in primary care has yet to be established.
Summarize current evidence for the usefulness of imaging markers for AD in primary compared to specialized care settings.
Selective overview of the literature, and pilot data on the use of MRI-based hippocampus and basal forebrain volumetry for the discrimination of AD dementia and mild cognitive impairment (MCI) cases from healthy controls in 58 cases from a primary care cohort and 58 matched cases from a memory clinic's sample.
Molecular imaging marker of amyloid pathology, and volumetric markers of regional and whole brain atrophy support the diagnosis of AD dementia and MCI due to AD, and contribute to confidence in the differential diagnosis of AD and non-AD related dementias in specialized care. Limited evidence from the literature and our primary care cohort suggests that the diagnostic accuracy of volumetric imaging markers may be similar in the dementia stage of AD, but may be inferior for cases with MCI in primary compared with specialized care.
Evidence is still widely lacking on the use of imaging markers for early and differential diagnosis of AD dementia, and detection of prodromal AD in primary care. Further progress to fill this gap will depend on the availability of international multimodal data from well-defined primary care cohorts.
在研究环境和专科护理中，已广泛探索使用成像标志物来诊断阿尔茨海默病（AD）的痴呆前期和早期痴呆阶段。这些标志物在初级护理中的应用尚未确立。
总结与专科护理环境相比，成像标志物在初级护理中对AD的有用性的当前证据。
对文献进行选择性综述，并展示基于MRI的海马体和基底前脑体积测量在58例初级护理队列中的AD痴呆和轻度认知障碍（MCI）病例与58例记忆诊所样本中的匹配病例与健康对照进行鉴别的试点数据。
淀粉样蛋白病理学的分子成像标志物以及区域和全脑萎缩的体积标志物支持AD痴呆和由AD引起的MCI的诊断，并有助于在专科护理中对AD和非AD相关痴呆进行鉴别诊断时增强信心。文献和我们的初级护理队列中的有限证据表明，体积成像标志物在AD痴呆阶段的诊断准确性可能相似，但与专科护理相比，在初级护理中对MCI病例的诊断准确性可能较低。
在初级护理中，关于使用成像标志物进行AD痴呆的早期和鉴别诊断以及前驱AD的检测，仍然广泛缺乏证据。填补这一空白的进一步进展将取决于来自明确界定的初级护理队列的国际多模态数据的可用性。
