Rostamzadeh Ayda, Jessen Frank
Klinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Medizinische Fakultät, Köln, Deutschland.
Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Deutschland.
Nervenarzt. 2020 Sep;91(9):832-842. doi: 10.1007/s00115-020-00907-y.
Mild cognitive impairment (MCI) is characterized by cognitive deficits but essentially preserved competence in activities of daily living. It is a risk factor for the development of dementia and can reflect a prodromal predementia state of Alzheimer's disease (AD). The pathology of AD is defined by cerebral deposition of amyloid-beta-1-42 protein and aggregation of phosphorylated tau protein, which can be identified in vivo by biomarkers for these alterations. As a result of advances in the field of biomarker-based early detection of AD, it is possible to differentiate between MCI patients with and without a pathological AD condition and therefore, between patients with a low and those with a high risk for the development of dementia. At present there are no specific guideline recommendations in Germany for the diagnostic use of biomarkers in predementia detection of AD and for dementia risk assessment in patients with MCI. This article summarizes the current recommendations of a European expert consensus publication and a multidisciplinary working group of the Alzheimer's Association on the clinical application of cerebrospinal fluid (CSF) biomarkers for the diagnostics of AD in patients with MCI. If the clinical diagnostic criteria for MCI are fulfilled according to the medical history and neuropsychological testing, it is recommended to carry out further diagnostics (blood test, brain imaging) in order to more precisely define the differential diagnostic classification. Counseling on the potential benefits, limits and risks of biomarker testing for early AD detection and dementia risk prediction should always precede assessment of CSF biomarkers. Information about the individual risk of developing dementia has potential consequences for the psychological well-being and life planning; therefore, clinical follow-up visits are recommended.
轻度认知障碍（MCI）的特征是存在认知缺陷，但日常生活活动能力基本保持完好。它是痴呆症发展的一个风险因素，可能反映阿尔茨海默病（AD）的前驱性痴呆前期状态。AD的病理学特征是β-淀粉样蛋白1-42在大脑中沉积以及磷酸化tau蛋白聚集，这些改变可通过生物标志物在体内进行识别。由于基于生物标志物的AD早期检测领域取得了进展，现在有可能区分患有和未患有AD病理状况的MCI患者，从而区分痴呆症发展风险低和高的患者。目前在德国，对于AD痴呆前期检测中生物标志物的诊断应用以及MCI患者的痴呆风险评估，尚无具体的指南建议。本文总结了欧洲专家共识出版物以及阿尔茨海默病协会多学科工作组关于脑脊液（CSF）生物标志物在MCI患者AD诊断中的临床应用的当前建议。如果根据病史和神经心理学测试符合MCI的临床诊断标准，建议进行进一步诊断（血液检测、脑部成像），以便更精确地确定鉴别诊断分类。在评估CSF生物标志物之前，应始终就生物标志物检测对AD早期检测和痴呆风险预测的潜在益处、局限性和风险进行咨询。关于个体患痴呆症风险的信息对心理健康和生活规划可能产生影响；因此，建议进行临床随访。
