Yosypyshyn Dariia, Kučikienė Domantė, Ramakers Inez, Schulz Jörg B, Reetz Kathrin, Costa Ana Sofia
Department of Neurology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
Neurol Res Pract. 2023 Aug 3;5(1):40. doi: 10.1186/s42466-023-00262-8.
The AT(N) research framework for Alzheimer's disease (AD) remains unclear on how to best deal with borderline cases. Our aim was to characterise patients with suspected AD with a borderline Aß/Aß ratio in cerebrospinal fluid.
We analysed retrospective data from two cohorts (memory clinic cohort and ADNI) of patients (n = 63) with an Aß/Aß ratio within a predefined borderline area-Q above the validated cut-off value(grey zone). We compared demographic, clinical, neuropsychological and neuroimaging features between grey zone patients and patients with low Aß (normal Aß ratio but pathological Aß, n = 42) and patients with AD (pathological Aß, P-Tau, und T-Tau, n = 80).
Patients had mild cognitive impairment or mild dementia and a median age of 72 years. Demographic and general clinical characteristics did not differ between the groups. Patients in the grey zone group were the least impaired in cognition. However, they overlapped with the low Aß group in verbal episodic memory performance, especially in delayed recall and recognition. The grey zone group had less severe medial temporal atrophy, but mild posterior atrophy and mild white matter hyperintensities, similar to the low Aß group.
Patients in the Aß ratio grey zone were less impaired, but showed clinical overlap with patients on the AD continuum. These borderline patients may be at an earlier disease stage. Assuming an increased risk of AD and progressive cognitive decline, careful consideration of clinical follow-up is recommended when using dichotomous approaches to classify Aß status.
阿尔茨海默病（AD）的AT(N)研究框架在如何最好地处理临界病例方面仍不明确。我们的目的是对脑脊液中Aβ/Aβ比值处于临界值的疑似AD患者进行特征描述。
我们分析了来自两个队列（记忆门诊队列和ADNI）的回顾性数据，这些队列中的患者（n = 63）的Aβ/Aβ比值处于预定义的临界区域-Q内，高于验证后的临界值（灰色区域）。我们比较了灰色区域患者与低Aβ患者（Aβ比值正常但Aβ病理状态，n = 42）以及AD患者（Aβ、P- Tau和T- Tau病理状态，n = 80）之间的人口统计学、临床、神经心理学和神经影像学特征。
患者患有轻度认知障碍或轻度痴呆，中位年龄为72岁。各组之间的人口统计学和一般临床特征没有差异。灰色区域组的患者认知损害最小。然而，他们在言语情景记忆表现方面与低Aβ组重叠，尤其是在延迟回忆和识别方面。灰色区域组的内侧颞叶萎缩较轻，但有轻度的后部萎缩和轻度的白质高信号，与低Aβ组相似。
Aβ比值处于灰色区域的患者损害较轻，但与AD连续体上的患者存在临床重叠。这些临界患者可能处于疾病的早期阶段。假设AD风险增加和认知功能进行性下降，在使用二分法对Aβ状态进行分类时，建议仔细考虑临床随访。
