Rossini Paolo Maria, Miraglia Francesca, Alù Francesca, Cotelli Maria, Ferreri Florinda, Iorio Riccardo Di, Iodice Francesco, Vecchio Fabrizio
Brain Connectivity Laboratory, Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele Pisana, 00167 Rome, Italy.
Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di DioFatebenefratelli, 25125 Brescia, Italy.
J Pers Med. 2020 Apr 30;10(2):34. doi: 10.3390/jpm10020034.
Neurodegenerative processes of various types of dementia start years before symptoms, but the presence of a "neural reserve", which continuously feeds and supports neuroplastic mechanisms, helps the aging brain to preserve most of its functions within the "normality" frame. Mild cognitive impairment (MCI) is an intermediate stage between dementia and normal brain aging. About 50% of MCI subjects are already in a stage that is prodromal-to-dementia and during the following 3 to 5 years will develop clinically evident symptoms, while the other 50% remains at MCI or returns to normal. If the risk factors favoring degenerative mechanisms are modified during early stages (i.e., in the prodromal), the degenerative process and the loss of abilities in daily living activities will be delayed. It is therefore extremely important to have biomarkers able to identify-in association with neuropsychological tests-prodromal-to-dementia MCI subjects as early as possible. MCI is a large (i.e., several million in EU) and substantially healthy population; therefore, biomarkers should be financially affordable, largely available and non-invasive, but still accurate in their diagnostic prediction. Neurodegeneration initially affects synaptic transmission and brain connectivity; methods exploring them would represent a 1st line screening. Neurophysiological techniques able to evaluate mechanisms of synaptic function and brain connectivity are attracting general interest and are described here. Results are quite encouraging and suggest that by the application of artificial intelligence (i.e., learning-machine), neurophysiological techniques represent valid biomarkers for screening campaigns of the MCI population.
各类痴呆症的神经退行性过程在出现症状前数年就已开始，但“神经储备”的存在持续滋养和支持神经可塑性机制，有助于衰老的大脑在“正常”范围内保留其大部分功能。轻度认知障碍（MCI）是痴呆症与正常脑老化之间的中间阶段。约50%的MCI患者已处于痴呆症前驱阶段，在接下来的3至5年内将出现明显的临床症状，而另外50%则维持在MCI状态或恢复正常。如果在早期阶段（即前驱期）改变有利于退行性机制的危险因素，退行性过程和日常生活活动能力的丧失将会延迟。因此，拥有能够与神经心理学测试相结合尽早识别痴呆症前驱期MCI患者的生物标志物极为重要。MCI是一个庞大的群体（在欧盟有数百万人）且基本健康；因此，生物标志物应在经济上可承受、广泛可得且无创，但在诊断预测方面仍需准确。神经退行性变最初影响突触传递和脑连接；探索这些方面的方法将代表一线筛查。能够评估突触功能和脑连接机制的神经生理学技术正引起广泛关注，本文对此进行描述。结果相当令人鼓舞，表明通过应用人工智能（即学习机器），神经生理学技术是MCI人群筛查活动的有效生物标志物。
