Huang Lin, Li Qinjie, Lu Yao, Pan Fengfeng, Cui Liang, Wang Ying, Miao Ya, Chen Tianlu, Li Yatian, Wu Jingnan, Chen Xiaochun, Jia Jianping, Guo Qihao
Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gen Psychiatr. 2024 Feb 1;37(1):e101310. doi: 10.1136/gpsych-2023-101310. eCollection 2024.
Alzheimer's disease (AD) is a common cause of dementia, characterised by cerebral amyloid-β deposition, pathological tau and neurodegeneration. The prodromal stage of AD (pAD) refers to patients with mild cognitive impairment (MCI) and evidence of AD's pathology. At this stage, disease-modifying interventions should be used to prevent the progression to dementia. Given the inherent heterogeneity of MCI, more specific biomarkers are needed to elucidate the underlying AD's pathology. Although the uses of cerebrospinal fluid and positron emission tomography are widely accepted methods for detecting AD's pathology, their clinical applications are limited by their high costs and invasiveness, particularly in low-income areas in China. Therefore, to improve the early detection of Alzheimer's disease (AD) pathology through cost-effective screening methods, a panel of 45 neurologists, psychiatrists and gerontologists was invited to establish a formal consensus on the screening of pAD in China. The supportive evidence and grades of recommendations are based on a systematic literature review and focus group discussion. National meetings were held to allow participants to review, vote and provide their expert opinions to reach a consensus. A majority (two-thirds) decision was used for questions for which consensus could not be reached. Recommended screening methods are presented in this publication, including neuropsychological assessment, peripheral biomarkers and brain imaging. In addition, a general workflow for screening pAD in China is established, which will help clinicians identify individuals at high risk and determine therapeutic targets.
阿尔茨海默病（AD）是痴呆的常见病因，其特征为脑淀粉样β蛋白沉积、病理性tau蛋白及神经退行性变。AD的前驱期（pAD）指轻度认知障碍（MCI）且有AD病理学证据的患者。在此阶段，应采用疾病修饰干预措施以预防进展为痴呆。鉴于MCI固有的异质性，需要更具特异性的生物标志物来阐明潜在的AD病理学特征。尽管脑脊液检测和正电子发射断层扫描是检测AD病理学特征的广泛认可的方法，但其临床应用受到高成本和侵入性的限制，在中国低收入地区尤其如此。因此，为通过具有成本效益的筛查方法改善阿尔茨海默病（AD）病理学特征的早期检测，邀请了45名神经科医生、精神科医生和老年病学家组成的小组就中国pAD的筛查达成正式共识。支持证据和推荐等级基于系统的文献综述和焦点小组讨论。召开了全国会议，让参与者进行审查、投票并提供专家意见以达成共识。对于无法达成共识的问题，采用多数（三分之二）决定。本出版物介绍了推荐的筛查方法，包括神经心理学评估、外周生物标志物和脑成像。此外，还建立了中国pAD筛查的一般工作流程，这将有助于临床医生识别高危个体并确定治疗靶点。
