根据生物性阿尔茨海默病阶段划分的临床进展率。

Rates of clinical progression according to biological Alzheimer's disease stages.

作者信息

Trudel Lydia, Therriault Joseph, Macedo Arthur C, Servaes Stijn, Hosseini Seyyed Ali, Bezgin Gleb, Rahmouni Nesrine, Chan Tevy, Fernandez-Arias Jaime, Aumont Étienne, Wang Yi-Ting, Zheng Yansheng, Hall Brandon, Hopewell Robert, Hsiao Chris Hung-Hsin, Toga Arthur W, Braskie Meredith N, Meeker Karin L, Soucy Jean-Paul, Gauthier Serge, Vitali Paolo, O'Bryant Sid E, Pascoal Tharick A, Rosa-Neto Pedro

机构信息

Translational Neuroimaging Laboratory Department of Neurology and Neurosurgery, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.

McGill University Research Centre for Studies in Aging, Douglas Hospital Research Centre - Centre intégré universitaire de santé et services sociaux de l'Ouest-de-l'Île-de-Montréal, Montreal, Québec, Canada.

出版信息

Alzheimers Dement. 2025 Sep;21(9):e70624. doi: 10.1002/alz.70624.

DOI:10.1002/alz.70624

PMID:40951978

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12434706/

Abstract

INTRODUCTION

Predicting the rate of cognitive decline and the likelihood of progression to dementia remains a critical unmet need in clinical settings.

METHODS

We assessed progression to mild cognitive impairment (MCI) and all-cause dementia in 492 individuals from the TRIAD, ADNI, and HABS-HD cohorts followed for an average of 2.49 years. Amyloid-positive participants were staged according to the Alzheimer's Association biological staging framework (A+T-/A+T+/A+T+/A+T+).

RESULTS

Cognitively unimpaired (CU) individuals in the A+T+, A+T+, and A+T+ biological Alzheimer's disease (AD) stages were at significantly higher risk of clinical progression compared to non-AD CU individuals. In individuals with MCI, advanced tau stage was associated with an 83% likelihood of developing dementia over 4 years. Biological AD staging demonstrated superior accuracy in predicting clinical progression compared to amyloid-PET (positron emission tomography) status, tau-PET status, and demographic information. All tau-PET-positive individuals showed a significantly faster rate of cognitive decline than non-AD controls, with the A+T+ stage showing the steepest rate of decline (p < 0.001).

DISCUSSION

Our results highlight the prognostic value of biological AD staging.

HIGHLIGHTS

Cognitively unimpaired (CU) individuals in all tau-PET (positron emission tomography)-positive biological Alzheimer's disease (AD) stages were at significantly higher risk of clinical progression compared to individuals without AD. In individuals with mild cognitive impairment (MCI), only the A+T+ stage reached a point where 50% of individuals had progressed to all-cause dementia, after 2.36 years. Biological AD staging demonstrated superior accuracy in predicting clinical progression to dementia compared to other PET biomarkers and demographic information. All tau-PET-positive individuals showed a significantly faster rate of cognitive decline than individuals without AD, with the A+T+ stage showing the steepest rate of decline.

摘要

引言

预测认知衰退的速度以及进展为痴呆症的可能性，仍然是临床环境中一项尚未满足的关键需求。

方法

我们评估了来自TRIAD、ADNI和HABS-HD队列的492名个体进展为轻度认知障碍（MCI）和全因性痴呆症的情况，平均随访2.49年。淀粉样蛋白阳性参与者根据阿尔茨海默病协会生物分期框架（A+T-/A+T+/A+T+/A+T+）进行分期。

结果

与非阿尔茨海默病认知未受损（CU）个体相比，处于A+T+、A+T+和A+T+生物性阿尔茨海默病（AD）阶段的认知未受损个体临床进展风险显著更高。在MCI个体中，tau蛋白晚期阶段与4年内发展为痴呆症的可能性为83%相关。与淀粉样蛋白正电子发射断层扫描（PET）状态、tau蛋白PET状态和人口统计学信息相比，生物性AD分期在预测临床进展方面显示出更高的准确性。所有tau蛋白PET阳性个体的认知衰退速度明显快于非AD对照组，A+T+阶段衰退速度最快（p<0.001）。

讨论

我们的结果突出了生物性AD分期的预后价值。

重点

与无AD个体相比，所有tau蛋白正电子发射断层扫描（PET）阳性生物性阿尔茨海默病（AD）阶段的认知未受损（CU）个体临床进展风险显著更高。在轻度认知障碍（MCI）个体中，仅A+T+阶段在2.36年后达到50%的个体进展为全因性痴呆症的程度。与其他PET生物标志物和人口统计学信息相比，生物性AD分期在预测临床进展为痴呆症方面显示出更高的准确性。所有tau蛋白PET阳性个体的认知衰退速度明显快于无AD个体，A+T+阶段衰退速度最快。