用于检测轻度认知障碍中路易体病与阿尔茨海默病的标志物：系统评价和荟萃分析。

Markers for the detection of Lewy body disease versus Alzheimer's disease in mild cognitive impairment: a systematic review and meta-analysis.

机构信息

Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy.

International School of Advanced Studies, University of Camerino, Camerino, Italy.

出版信息

Aging Clin Exp Res. 2024 Mar 7;36(1):60. doi: 10.1007/s40520-024-02704-y.

DOI:10.1007/s40520-024-02704-y

PMID:38451331

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10920203/

Abstract

BACKGROUND

Mild cognitive impairment (MCI) may evolve into dementia. Early recognition of possible evolution to Alzheimer's disease (AD) and dementia with Lewy Bodies (DLB) is of importance, but actual diagnostic criteria have some limitations. In this systematic review and meta-analysis, we aimed to find the most accurate markers that can discriminate patients with DLB versus AD, in MCI stage.

METHODS

We searched several databases up to 17 August 2023 including studies comparing markers that may distinguish DLB-MCI from AD-MCI. We reported data regarding sensitivity, specificity, and the area under the curves (AUCs) with their 95% confidence intervals (CIs).

RESULTS

Among 2219 articles initially screened, eight case-control studies and one cohort study were included for a total of 832 outpatients with MCI. The accuracy of cerebrospinal fluid (CSF) markers was the highest among the markers considered (AUC > 0.90 for the CSF markers), with the AUC of CSF Aβ42/Aβ40 of 0.94. The accuracy for clinical symptom scales was very good (AUC = 0.93), as evaluated in three studies. Although limited to one study, the accuracy of FDG-PET (cingulate island sign ratio) was very good (AUC = 0.95) in discriminating DLB from AD in MCI, while the accuracy of SPECT markers and EEG frequencies was variable.

CONCLUSIONS

Few studies have assessed the accuracy of biomarkers and clinical tools to distinguish DLB from AD at the MCI stage. While results are promising for CSF markers, FDG-PET and clinical symptoms scales, more studies, particularly with a prospective design, are needed to evaluate their accuracy and clinical usefulness.

CLINICAL TRIAL REGISTRATION

Prospero (CRD42023422600).

摘要

背景

轻度认知障碍（MCI）可能会发展为痴呆。早期识别可能向阿尔茨海默病（AD）和路易体痴呆（DLB）发展非常重要，但实际的诊断标准存在一些局限性。在这项系统评价和荟萃分析中，我们旨在寻找最准确的标志物，以区分 MCI 阶段的 DLB 患者和 AD 患者。

方法

我们检索了多个数据库，截至 2023 年 8 月 17 日，包括比较可能区分 DLB-MCI 与 AD-MCI 的标志物的研究。我们报告了数据，包括敏感性、特异性和曲线下面积（AUC）及其 95%置信区间（CI）。

结果

在最初筛选的 2219 篇文章中，有 8 项病例对照研究和 1 项队列研究被纳入，共纳入 832 名 MCI 门诊患者。考虑到的标志物中，脑脊液（CSF）标志物的准确性最高（CSF Aβ42/Aβ40 的 AUC>0.90），而临床症状量表的准确性非常好（AUC=0.93），在三项研究中进行了评估。尽管仅局限于一项研究，但 FDG-PET（扣带回岛征比）在区分 MCI 中的 DLB 与 AD 方面的准确性非常好（AUC=0.95），而 SPECT 标志物和 EEG 频率的准确性则各不相同。