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神经自身抗体相关痴呆的当前疾病分类学

Current Nosology of Neural Autoantibody-Associated Dementia.

作者信息

Hansen Niels

机构信息

Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.

出版信息

Front Aging Neurosci. 2021 Jul 28;13:711195. doi: 10.3389/fnagi.2021.711195. eCollection 2021.

Abstract

BACKGROUND

The detection of neural autoantibodies in patients with cognitive decline is an increasingly frequent phenomenon in memory clinics, and demanding as it does a specific diagnostic approach and therapeutic management, it deserves greater attention. It is this review's aim to present the latest nosology of neural autoantibody-associated dementia.

METHODS

A specific literature research via PubMed was conducted to describe the nosology of neural autoantibody-associated dementia.

RESULTS

An autoimmune dementia comprises with an early onset, atypical clinical presentation and rapid progression in conjunction with neural antibodies, signs of inflammation in the cerebrospinal fluid, and a non-neurodegenerative pattern in neuroimaging. An autoimmune dementia is probably present if the patient responds to immunotherapy. Atypical dementia involving neural autoantibodies with mostly N-methyl-D-aspartate receptor antibodies might not fulfill all the autoimmune-dementia criteria, thus it may constitute an independent disease entity. Finally, a neurodegenerative dementia such as the frontotemporal type also coincides with neural autoantibodies such as the subunit ionotropic glutamate receptors 3 of amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antibodies, dementia with Lewy bodies with myelin oligodendrocytic protein, myelin basic protein antibodies, or Creutzfeldt-Jakob disease with Zic4 or voltage gated potassium channel antibodies. These dementia entities may well overlap in their clinical features and biomarkers, i.e., their neural autoantibodies or neuroimaging patterns.

CONCLUSION

There are three main forms of neural autoantibody-associated dementia we can distinguish that might also share certain features in their clinical and laboratory presentation. More research is urgently necessary to improve the diagnosis and therapy of these patients, as the progression of their dementia might thus be improved or even reversed.

摘要

背景

在记忆门诊中,认知功能减退患者神经自身抗体的检测日益常见,鉴于其需要特定的诊断方法和治疗管理,值得更多关注。本综述旨在介绍神经自身抗体相关痴呆的最新分类学。

方法

通过PubMed进行了一项特定的文献研究,以描述神经自身抗体相关痴呆的分类学。

结果

自身免疫性痴呆的特点是起病早、临床表现不典型、进展迅速,伴有神经抗体、脑脊液炎症迹象以及神经影像学上的非神经退行性模式。如果患者对免疫治疗有反应,则可能存在自身免疫性痴呆。涉及神经自身抗体(主要是N-甲基-D-天冬氨酸受体抗体)的非典型痴呆可能不完全符合自身免疫性痴呆的所有标准,因此可能构成一种独立的疾病实体。最后,诸如额颞叶型等神经退行性痴呆也与神经自身抗体同时出现,如氨基-3-羟基-5-甲基-4-异恶唑丙酸受体离子型谷氨酸受体3亚基抗体、路易体痴呆伴髓鞘少突胶质细胞蛋白、髓鞘碱性蛋白抗体,或克雅氏病伴Zic4或电压门控钾通道抗体。这些痴呆实体在临床特征和生物标志物方面,即神经自身抗体或神经影像学模式上,可能存在重叠。

结论

我们可以区分出三种主要的神经自身抗体相关痴呆形式,它们在临床和实验室表现上也可能有某些共同特征。迫切需要更多研究来改善这些患者的诊断和治疗,因为这样可能改善甚至逆转他们痴呆的进展。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ef6/8355817/604f7ea7c2db/fnagi-13-711195-g001.jpg

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