Aljuhani Manal, Ashraf Azhaar, Edison Paul
Radiological Science and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
Division of Neurology, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London W12 0NN, UK.
Brain Commun. 2024 Dec 3;6(6):fcae435. doi: 10.1093/braincomms/fcae435. eCollection 2024.
Alzheimer's disease is the most prevalent form of dementia in the elderly, which is clinically characterized by a gradual and progressive deterioration of cognitive functions. The central and early role of β-amyloid in the pathogenesis of Alzheimer's disease is supported by a plethora of studies including genetic analyses, biomarker research and genome-wide association studies in both familial (early-onset) and sporadic (late-onset) forms of Alzheimer's. Monoclonal antibodies directed against β-amyloid demonstrate slowing of the clinical deterioration of patients with early Alzheimer's disease. Aducanumab, lecanemab and donanemab clinical trials showed slowing of Alzheimer's disease progression on composite scores by 25-40% based on the measure used. Anti-β-amyloid antibodies can cause side effects of bleeding and swelling in the brain, called amyloid-related imaging abnormalities. Amyloid-related imaging abnormalities typically occur early in treatment and are often asymptomatic, and though in rare cases, they can lead to serious or life-threatening events. The aim of this review is to evaluate the clinical meaningfulness of anti-β-amyloid therapies amidst amyloid-related imaging abnormalities concern in Alzheimer's disease.
阿尔茨海默病是老年人中最常见的痴呆形式，其临床特征是认知功能逐渐进行性衰退。包括基因分析、生物标志物研究以及家族性（早发型）和散发性（晚发型）阿尔茨海默病的全基因组关联研究在内的大量研究均支持β-淀粉样蛋白在阿尔茨海默病发病机制中的核心和早期作用。针对β-淀粉样蛋白的单克隆抗体显示可减缓早期阿尔茨海默病患者的临床衰退。阿杜卡努单抗、乐卡努单抗和多奈单抗的临床试验表明，根据所采用的测量方法，阿尔茨海默病进展的综合评分减缓了25%至40%。抗β-淀粉样蛋白抗体可引起脑部出血和肿胀的副作用，称为淀粉样蛋白相关成像异常。淀粉样蛋白相关成像异常通常在治疗早期出现，且往往无症状，尽管在极少数情况下，它们可导致严重或危及生命的事件。本综述的目的是在阿尔茨海默病中存在淀粉样蛋白相关成像异常问题的情况下，评估抗β-淀粉样蛋白疗法的临床意义。
