Continuum (Minneap Minn). 2022 Jun 1;28(3):648-675. doi: 10.1212/CON.0000000000001131.
Alzheimer disease (AD) is the most common cause of dementia in adults (mid to late life), highlighting the importance of understanding the risk factors, clinical manifestations, and recent developments in diagnostic testing and therapeutics.
Advances in fluid (CSF and blood-based) and imaging biomarkers are allowing for a more precise and earlier diagnosis of AD (relative to non-AD dementias) across the disease spectrum and in patients with atypical clinical features. Specifically, tau- and amyloid-related AD pathologic changes can now be measured by CSF, plasma, and positron emission tomography (PET) with good precision. Additionally, a better understanding of risk factors for AD has highlighted the need for clinicians to address comorbidities to maximize prevention of cognitive decline in those at risk or to slow decline in patients who are symptomatic. Recent clinical trials of amyloid-lowering drugs have provided not only some optimism that amyloid reduction or prevention may be beneficial but also a recognition that addressing additional targets will be necessary for significant disease modification.
Recent developments in fluid and imaging biomarkers have led to the improved understanding of AD as a chronic condition with a protracted presymptomatic phase followed by the clinical stage traditionally recognized by neurologists. As clinical trials of potential disease-modifying therapies continue, important developments in the understanding of the disease will improve clinical care now and lead to more effective therapies in the near future.
阿尔茨海默病（AD）是成人（中晚期）最常见的痴呆症病因，这凸显了理解 AD 的风险因素、临床表现以及诊断测试和治疗的最新进展的重要性。
在疾病谱中以及具有非典型临床特征的患者中，基于体液（CSF 和血液）和影像学的生物标志物的进步使得 AD（相对于非 AD 痴呆症）的诊断更加精确和更早。具体而言，通过 CSF、血浆和正电子发射断层扫描（PET）可以很好地精确测量与 tau 和淀粉样蛋白相关的 AD 病理变化。此外，对 AD 风险因素的更好理解突出表明临床医生需要解决合并症，以最大程度地预防有风险的人认知能力下降，或减缓有症状患者的下降速度。最近针对淀粉样蛋白降低药物的临床试验不仅提供了一些乐观的证据，即淀粉样蛋白的减少或预防可能有益，而且还认识到需要针对其他靶点进行治疗，才能实现疾病的显著改善。
体液和影像学生物标志物的最新进展使得人们对 AD 有了更深入的理解，AD 是一种慢性疾病，具有较长的无症状前阶段，随后是传统上被神经科医生所认识的临床阶段。随着针对潜在疾病修饰疗法的临床试验的继续，对该疾病的理解的重要进展将改善当前的临床护理，并在不久的将来带来更有效的治疗方法。
