Tahami Monfared Amir Abbas, Byrnes Michael J, White Leigh Ann, Zhang Quanwu
Eisai, 200 Metro Blvd, Nutley, NJ, 07110, USA.
Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
Neurol Ther. 2022 Jun;11(2):553-569. doi: 10.1007/s40120-022-00338-8. Epub 2022 Mar 14.
Alzheimer's disease (AD) is prevalent throughout the world and is the leading cause of dementia in older individuals (aged ≥ 65 years). To gain a deeper understanding of the recent literature on the epidemiology of AD and its progression, we conducted a review of the PubMed-indexed literature (2014-2021) in North America, Europe, and Asia. The worldwide toll of AD is evidenced by rising prevalence, incidence, and mortality due to AD-estimates which are low because of underdiagnosis of AD. Mild cognitive impairment (MCI) due to AD can ultimately progress to AD dementia; estimates of AD dementia etiology among patients with MCI range from 40% to 75% depending on the populations studied and whether the MCI diagnosis was made clinically or in combination with biomarkers. The risk of AD dementia increases with progression from normal cognition with no amyloid-beta (Aβ) accumulation to early neurodegeneration and subsequently to MCI. For patients with Aβ accumulation and neurodegeneration, lifetime risk of AD dementia has been estimated to be 41.9% among women and 33.6% among men. Data on progression from preclinical AD to MCI are sparse, but an analysis of progression across the three preclinical National Institute on Aging and Alzheimer's Association (NIA-AA) stages suggests that NIA-AA stage 3 (subtle cognitive decline with AD biomarker positivity) could be useful in combination with other tools for treatment decision-making. Factors shown to increase risk include lower Mini-Mental State Examination (MMSE) score, higher Alzheimer's Disease Assessment Scale (ADAS-cog) score, positive APOE4 status, white matter hyperintensities volume, entorhinal cortex atrophy, cerebrospinal fluid (CSF) total tau, CSF neurogranin levels, dependency in instrumental activities of daily living (IADL), and being female. Results suggest that use of biomarkers alongside neurocognitive tests will become an important part of clinical practice as new disease-modifying therapies are introduced.
阿尔茨海默病（AD）在全球范围内普遍存在，是老年个体（年龄≥65岁）痴呆的主要原因。为了更深入地了解近期关于AD流行病学及其进展的文献，我们对北美、欧洲和亚洲PubMed索引的文献（2014 - 2021年）进行了综述。AD在全球造成的影响体现在其患病率、发病率和死亡率不断上升，由于AD诊断不足，这些估计数偏低。由AD导致的轻度认知障碍（MCI）最终可能发展为AD痴呆；根据所研究的人群以及MCI诊断是通过临床诊断还是结合生物标志物进行，MCI患者中AD痴呆病因的估计范围为40%至75%。AD痴呆的风险随着从无淀粉样β蛋白（Aβ）积累的正常认知发展到早期神经退行性变，随后发展为MCI而增加。对于有Aβ积累和神经退行性变的患者，估计女性患AD痴呆的终生风险为41.9%，男性为33.6%。关于从临床前AD进展到MCI的数据很少，但对美国国立衰老研究所和阿尔茨海默病协会（NIA - AA）临床前三个阶段进展的分析表明，NIA - AA第3阶段（伴有AD生物标志物阳性的轻微认知下降）与其他工具结合可用于治疗决策。已显示会增加风险的因素包括较低的简易精神状态检查表（MMSE）评分、较高的阿尔茨海默病评估量表（ADAS - cog）评分、APOE4阳性状态、白质高信号体积、内嗅皮质萎缩、脑脊液（CSF）总tau蛋白、CSF神经颗粒素水平、日常生活工具性活动（IADL）依赖以及女性。结果表明，随着新的疾病修饰疗法的引入，将生物标志物与神经认知测试一起使用将成为临床实践的重要组成部分。
