Department for Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany.
Department of Medical Ethics and History of Medicine, University Medical Center Goettingen, Goettingen, Germany.
J Alzheimers Dis. 2020;78(3):1137-1148. doi: 10.3233/JAD-200794.
The National Institute of Aging and Alzheimer's Association's diagnostic recommendations for preclinical Alzheimer's disease (AD) and mild cognitive impairment (MCI) define AD by pathological processes which can be detected by biomarkers. These criteria were established as part of a research framework intended for research purposes but progressively enter the clinical practice.
We investigated the availability, frequency of use, interpretation, and therapeutic implications of biomarkers for the etiologic diagnosis and prognosis in MCI and subjective cognitive decline (SCD) in routine clinical care.
We conducted a cross-sectional questionnaire survey among 215 expert dementia centers (hospitals and memory clinics) in Germany.
From the 98 centers (45.6% of contacted centers) included, two-thirds reported use of the cerebrospinal fluid (CSF) biomarkers Aβ42, tau, and phospho-tau in the diagnostic workup of MCI and one third in SCD. CSF biomarker analysis was more often employed by neurological (MCI 84%; SCD 42%) compared to psychiatric institutions (MCI 61%; SCD 33%; p≤0.001). Although dementia experts disagreed on the risk of progression associated with different CSF biomarker constellations, CSF biomarker results guided therapeutic decisions: ∼40% of responders reported to initiate cholinesterase inhibitor therapy in MCI and 18% in SCD (p = 0.006), given that all CSF biomarkers were in the pathological range.
Considering the vast heterogeneity among dementia expert centers in use of CSF biomarker analysis, interpretation of results, and therapeutic consequences, a standardization of biomarker-based diagnosis practice in pre-dementia stages is needed.
美国国家老龄化研究所和阿尔茨海默病协会的临床前阿尔茨海默病（AD）和轻度认知障碍（MCI）诊断建议通过生物标志物来检测病理过程，从而定义 AD。这些标准是作为研究框架的一部分制定的，旨在用于研究目的，但逐渐进入临床实践。
我们调查了生物标志物在常规临床护理中对 MCI 和主观认知下降（SCD）的病因诊断和预后的可用性、使用频率、解释和治疗意义。
我们对德国 215 家专家痴呆症中心（医院和记忆诊所）进行了横断面问卷调查。
从纳入的 98 家中心（占联系中心的 45.6%）中，三分之二报告在 MCI 的诊断工作中使用了脑脊液（CSF）生物标志物 Aβ42、tau 和磷酸化 tau，三分之一在 SCD 中使用。与精神病学机构（MCI 61%；SCD 33%；p≤0.001）相比，神经科（MCI 84%；SCD 42%）更常进行 CSF 生物标志物分析。尽管痴呆症专家对不同 CSF 生物标志物组合相关的进展风险存在分歧，但 CSF 生物标志物结果指导了治疗决策：约 40%的应答者报告在 MCI 中开始使用胆碱酯酶抑制剂治疗，18%在 SCD 中（p=0.006），因为所有 CSF 生物标志物均处于病理范围。
考虑到痴呆症专家中心在 CSF 生物标志物分析的使用、结果解释和治疗后果方面存在巨大差异，需要对基于生物标志物的预痴呆阶段诊断实践进行标准化。
