Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China.
J Alzheimers Dis. 2024;101(1):1-12. doi: 10.3233/JAD-240684.
Advances in biomarker-based diagnostic modalities, recent approval of anti-amyloid monoclonal antibodies for early Alzheimer's disease (AD; mild cognitive impairment or mild dementia due to AD) and late-stage clinical development of other disease-modifying therapies for AD necessitate a significant paradigm shift in the early detection, diagnosis and management of AD. Anti-amyloid monoclonal antibodies target the underlying pathophysiological mechanisms of AD and have demonstrated a significant reduction in the rate of clinical decline in cognitive and functional outcome measures in patients with early AD. With growing recognition of the benefit of early interventions in AD, an increasing number of people may seek diagnosis for their subjective cognitive problems in an already busy medical system. Various factors such as limited examination time, lack of expertise for cognitive assessment and limited access to specialized tests can impact diagnostic accuracy and timely detection of AD. To overcome these challenges, a new model of care will be required. In this paper, we provide practical guidance for institutional readiness for anti-amyloid therapies for early AD in Asia, in terms of best practices for identifying eligible patients and diagnosing them appropriately, safe administration of anti-amyloid monoclonal antibodies and monitoring of treatment, managing potential adverse events such as infusion reactions and amyloid-related imaging abnormalities, and cross-disciplinary collaboration. Education and training will be the cornerstone for the establishment of new pathways of care for the identification of patients with early AD and delivery of anti-amyloid therapies in a safe and efficient manner to eligible patients.
基于生物标志物的诊断方法的进步、抗淀粉样蛋白单克隆抗体最近被批准用于早期阿尔茨海默病（AD；由于 AD 导致的轻度认知障碍或轻度痴呆）以及其他针对 AD 的疾病修饰疗法的晚期临床开发，都需要在 AD 的早期检测、诊断和管理方面进行重大的范式转变。抗淀粉样蛋白单克隆抗体针对 AD 的潜在病理生理机制，在早期 AD 患者的认知和功能结果测量的临床下降率方面显示出显著降低。随着对 AD 早期干预益处的认识不断提高，越来越多的人可能会在已经繁忙的医疗系统中为自己的主观认知问题寻求诊断。各种因素，如检查时间有限、认知评估专业知识不足以及获得专门测试的机会有限，都可能影响诊断的准确性和 AD 的及时发现。为了克服这些挑战，需要一种新的护理模式。在本文中，我们就亚洲早期 AD 抗淀粉样蛋白治疗的机构准备情况提供了实用指导，包括确定合格患者和进行适当诊断、安全使用抗淀粉样蛋白单克隆抗体和监测治疗、管理输注反应和淀粉样相关成像异常等潜在不良事件以及跨学科合作的最佳实践。教育和培训将是为识别早期 AD 患者和以安全有效的方式为合格患者提供抗淀粉样蛋白治疗建立新护理途径的基石。
