Altoida Inc, Washington, DC, USA.
Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
Adv Exp Med Biol. 2023;1424:41-47. doi: 10.1007/978-3-031-31982-2_4.
SARS-CoV-2 effects on cognition are a vibrant area of active research. Many researchers suggest that COVID-19 patients with severe symptoms leading to hospitalization sustain significant neurodegenerative injury, such as encephalopathy and poor discharge disposition. However, despite some post-acute COVID-19 syndrome (PACS) case series that have described elevated neurodegenerative biomarkers, no studies have been identified that directly compared levels to those in mild cognitive impairment, non-PACS postoperative delirium patients after major non-emergent surgery, or preclinical Alzheimer's disease (AD) patients that have clinical evidence of Alzheimer's without symptoms. According to recent estimates, there may be 416 million people globally on the AD continuum, which include approximately 315 million people with preclinical AD. In light of all the above, a more effective application of digital biomarker and explainable artificial intelligence methodologies that explored amyloid beta, neuronal, axonal, and glial markers in relation to neurological complications in-hospital or later outcomes could significantly assist progress in the field. Easy and scalable subjects' risk stratification is of utmost importance, yet current international collaboration initiatives are still challenging due to the limited explainability and accuracy to identify individuals at risk or in the earliest stages that might be candidates for future clinical trials. In this open letter, we propose the administration of selected digital biomarkers previously discovered and validated in other EU-funded studies to become a routine assessment for non-PACS preoperative cognitive impairment, PACS neurological complications in-hospital, or later PACS and non-PACS improvement in cognition after surgery. The open letter also includes an economic analysis of the implications for such national-level initiatives. Similar collaboration initiatives could have existing pre-diagnostic detection and progression prediction solutions pre-screen the stage before and around diagnosis, enabling new disease manifestation mapping and pushing the field into unchartered territory.
SARS-CoV-2 对认知的影响是一个活跃的研究领域。许多研究人员认为，因严重症状而住院的 COVID-19 患者会遭受严重的神经退行性损伤，如脑病和预后不良。然而，尽管一些急性后期 COVID-19 综合征 (PACS) 病例系列描述了升高的神经退行性生物标志物，但没有发现直接将这些标志物水平与轻度认知障碍、非 PACS 大非紧急手术后术后谵妄患者或有临床阿尔茨海默病 (AD) 证据而无症状的临床前 AD 患者进行比较的研究。根据最近的估计，全球可能有 4.16 亿人处于 AD 连续体中，其中包括大约 3.15 亿临床前 AD 患者。鉴于所有这些情况，更有效地应用数字生物标志物和可解释的人工智能方法，探索与住院或以后的结果中的神经并发症相关的淀粉样蛋白 β、神经元、轴突和神经胶质标志物，可以极大地促进该领域的进展。对患者进行简便且可扩展的风险分层非常重要，但由于缺乏识别风险个体或处于早期阶段的个体的可解释性和准确性，目前的国际合作计划仍然具有挑战性，这些个体可能是未来临床试验的候选者。在这封公开信中，我们建议将之前在其他欧盟资助的研究中发现和验证的选定数字生物标志物纳入非 PACS 术前认知障碍、PACS 住院期间的神经并发症或术后 PACS 和非 PACS 的认知改善的常规评估。公开信还包括对这种国家级倡议的影响的经济分析。类似的合作计划可以利用现有的预诊断检测和进展预测解决方案来筛选诊断前和诊断期前后的阶段，从而实现新的疾病表现映射，并将该领域推向未知领域。
