NEW CRITERIA AND GUIDELINES FOR THE DIAGNOSIS OF ALZHEIMER’S DISEASE PUBLISHED FOR FIRST TIME IN 27 YEARS - Research Agenda Suggested for Detecting Pre-Symptomatic Alzheimer’s –- New Alzheimer’s Definition Moves Researchers Closer to Early Detection and Intervention –
CHICAGO, April 19, 2011 – For the first time in 27 years, new criteria and guidelines for the diagnosis of Alzheimer’s disease have been published by three expert workgroups spearheaded by the Alzheimer’s Association and the National Institute on Aging (NIA) of the National Institutes of Health (NIH).

The workgroups published four articles including ready-to-use clinical diagnostic criteria for Alzheimer’s disease dementia and mild cognitive impairment (MCI) due to Alzheimer’s. A research agenda was proposed for preclinical Alzheimer’s. The use of biomarkers in Alzheimer’s dementia and MCI due to Alzheimer’s was also proposed as a research agenda only, and is not intended for application in clinical settings at this time.

The articles – collectively, the National Institute on Aging/Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease – expand the definition of Alzheimer’s to include two new phases of the disease: (1) presymptomatic and (2) mildly symptomatic but pre-dementia, along with (3) dementia caused by Alzheimer’s. This reflects current thinking that Alzheimer’s begins creating distinct and measurable changes in the brains of affected people years, perhaps decades, before memory and thinking symptoms are noticeable.

“It is our hope that incorporating scientific knowledge gained and technological advances made over the past quarter century will improve current diagnosis, bring the field closer to earlier detection and treatment, and ultimately lead to effective disease-modifying therapies,” said William Thies, Ph.D., Chief Medical and Scientific Officer at the Alzheimer’s Association. “Development and publication of these articles is a major landmark in the field. That said, publication of these articles is not yet the end of the process of developing new diagnostic criteria for Alzheimer’s, but is another major step in the process.”

“The new guidelines reflect today’s understanding of how key changes in the brain lead to Alzheimer’s disease pathology and how they relate to the clinical signs of mild cognitive impairment and Alzheimer’s disease dementia,” said Creighton Phelps, Ph.D., Program Director of the Alzheimer’s Disease Centers Program at the National Institutes of Health. “We are also beginning to be able to detect these changes at a preclinical stage, long before symptoms appear in many people. With further research on biomarkers, as set forth in the new guidelines, we may ultimately be able to predict who is at risk for development of mild cognitive impairment and Alzheimer’s dementia, and who would benefit most as interventions are developed.”

The proposed new Alzheimer’s disease diagnostic guidelines were published online today by Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. Hard copy publication is scheduled for the May 2011 issue of the journal.

Three Stages of Alzheimer’s Disease

The current diagnostic criteria for Alzheimer’s*, for the most part, focus on reliable diagnosis when signs of problems in thinking, learning, and memory are noticeable to an individual, family, and friends. But research tells us that Alzheimer’s likely begins years, maybe even decades, prior to symptoms appearing.

The new articles refer to three phases of Alzheimer’s disease progression over time:
Preclinical Alzheimer’s Disease– Measurable changes in biomarkers (such as brain imaging and spinal fluid chemistry) that indicate the very earliest signs of disease, before outward symptoms are visible. Currently, there are no clinical diagnostic criteria for this phase, but the group provides a scientific framework to help researchers better define this stage of Alzheimer’s. (See supplement 5.)Mild cognitive impairment (MCI) due to Alzheimer’s Disease– Mild changes in memory and thinking abilities, enough to be noticed and measured, but not impairment that compromises everyday activities and functioning. Dementia due to Alzheimer’s Disease– Memory, thinking and behavioral symptoms that impair a person’s ability to function in daily life. (For more details, see supplement 3.)

According to the authors, in order to facilitate the possibility of future presymptomatic treatment of Alzheimer’s, it was important to define the disease from the earliest changes in the brain, not only the observable, symptomatic stages of the disease. The authors propose that Alzheimer’s begins with a long asymptomatic period during which detrimental changes are progressing in the brain, and individuals with biomarker evidence of these changes are at increased risk for developing cognitive and behavioral impairment and progression to Alzheimer’s dementia.

A biomarker is a naturally occurring, measurable substance or condition in the body that reliably indicates the presence or absence of disease or the risk of later developing a disease; for example, blood glucose levels are a biomarker of diabetes, and cholesterol levels are a biomarker of cardiovascular disease risk. Both fluid and imaging measures are being tested as possible biomarkers for Alzheimer’s. (See supplement 4.)

There was a broad consensus within the workgroups that much additional research needs to be done to validate the application of biomarkers as they are proposed in the newly-published articles. According to the authors, “The definitive studies … are likely to take more than a decade to fully accomplish. Thus, we must move quickly … and adjust our models and study designs as new data become available.”

“If we can definitively determine the risk of developing Alzheimer’s dementia in people who have biomarker evidence of brain changes but are not showing outward symptoms, we will open an important window of opportunity to intervene with disease-modifying therapies, once they are developed,” Thies said.

“In addition, the new criteria give us powerful tools to accelerate our knowledge in the fight against Alzheimer’s disease. They give us guidelines for getting a more accurate assessment of Alzheimer’s prevalence. In that way we can better assess the need for everything from research dollars to care services, to patient and caregiver education materials, to nursing home beds, to the number of gerontologists and nurses that we need. And, they give us a basis for creating the next generation of Alzheimer’s treatments that will be effective in each stage of the disease,” Thies said.

Moving the Field Toward Earlier Diagnosis and Treatment of Alzheimer’s

The Alzheimer’s Association, in its 2010 report titled “Changing the Trajectory of Alzheimer’s Disease: A National Imperative,” showed that a hypothetical intervention that delayed the onset of Alzheimer’s dementia by five years would result in a nearly 45 percent reduction in the number of people with Alzheimer’s by 2050, and reduce the projected Medicare costs of Alzheimer’s from $627 billion to $344 billion dollars.

The authors of the newly-released articles write, “It is our hope that the advances in preclinical detection of Alzheimer’s will enable earlier, more effective treatment, just as nearly all of therapeutic gains in cancer, cardiovascular disease, osteoporosis, and diabetes involve treatment before significant clinical symptoms are present. Screening and treatment programs instituted for other diseases … have already been associated with a decrease in mortality due to these conditions.”

Thies adds, “Currently, Alzheimer’s therapies are in development that may be able to slow or stop the progression of the disease. By improving early detection and risk evaluation, we will better be able to test potential therapies and eventually prescribe them for people at increased risk. Ultimately, this approach envisions for Alzheimer’s what is now common practice in cardiovascular disease, where early signs of risk – for example, in genetic markers or in blood cholesterol and/or blood pressure levels – can be treated to reduce the likelihood of heart attack or stroke later on.”

The challenge for Alzheimer’s now is that there is currently no single, generally accepted way to identify the disease in the earliest stage – before symptoms are evident. It is hoped that the research agenda outlined in the new preclinical Alzheimer’s article will correct this deficit.

Presymptomatic Disease Detection and Treatment – Not a New Idea, Except in Alzheimer’s

According to the authors, “The concept of a preclinical phase of disease should not be too foreign. Medical professionals readily acknowledge that cancer can be detected at the stage of ‘carcinoma in situ’ and that hypercholesterolemia and atherosclerosis can result in narrowing of coronary arteries that is detectable prior to myocardial infarction. It is widely acknowledged that symptoms are not necessary to diagnose human disease. Type II diabetes, hypertension, renal insufficiency, and osteoporosis are frequently detected through laboratory tests, and effective treatment can prevent the emergence of symptoms.”

“We should be open to the idea that Alzheimer’s could one day be diagnosed preclinically by the presence of biomarker evidence, which may eventually guide therapy prior to the onset of symptoms. We treat people with diabetes, elevated cholesterol, hypertension and a variety of other illnesses – we do not wait for strokes, heart attacks or other long term complications that we know will occur in significant numbers of those affected. Similarly, our intention is to use these criteria to better determine an individual’s risk of developing Alzheimer’s disease. This diagnostic research will help us discover the drugs of the future and prepare for the day when we can administer them to those at risk in order to prevent or delay the emergence of symptoms,” wrote the authors.

What Was Published

The proposed new diagnostic criteria and research agenda for Alzheimer’s disease are presented in three documents, plus an introduction.
One workgroup updated the 1984 diagnostic criteria for the dementia due to Alzheimer’s disease. Guy McKhann, M.D., Johns Hopkins University School of Medicine, Baltimore, and David Knopman, M.D., Mayo Clinic, Rochester, Minn., co-chaired this panel.A second workgroup focused on refining the criteria for the symptomatic, pre-dementia phase, referred to as Mild Cognitive Impairment due to Alzheimer’s disease. Marilyn Albert, Ph.D., Johns Hopkins University School of Medicine, Baltimore, chaired this workgroup.The third workgroup proposed a research agenda (NOT criteria for clinical diagnosis; this is an important distinction. See supplement 4.) for the asymptomatic, preclinical phase of Alzheimer’s. Reisa Sperling, M.D, Brigham and Women's Hospital, Harvard Medical School, Boston, chaired this group.The introduction provides an overview of the changes that have occurred in the Alzheimer’s field since the first diagnostic criteria were published in 1984, and outlines future challenges that need to be addressed. Clifford Jack, M.D., Mayo Clinic, Rochester, Minn., is lead author of this article.
Preliminary recommendations were announced in July 2010 at the Alzheimer’s Association International Conference on Alzheimer’s Disease (AAICAD). These early drafts were then made available for comment on the Alzheimer’s Association website, along with further presentation and discussion at a variety of medical and scientific meetings.

The three sets of recommendations differ in terms of relevance to current clinical practice.
The clinical diagnostic criteria for Alzheimer’s dementia and MCI due to Alzheimer’s are intended to guide diagnosis in the current clinical setting, such as a doctor’s office, including settings where no access to testing for biomarkers exists.The use of biomarkers in both Alzheimer’s dementia and MCI due to Alzheimer’s disease is intended only for research at this time. However, some biomarkers, especially those using advanced imaging techniques, could enter clinical practice in the near future, though much remains to be learned about their utility in this setting.The recommendations of the preclinical Alzheimer’s workgroup are intended for research purposes only, and do not have any clinical utility at this time.
A fourth workgroup has been organized to examine the postmortem, pathological criteria for Alzheimer’s. The results of their deliberations are expected to appear later in 2011.

27年內(nèi)首次出版發(fā)行的阿爾茨海默病診斷的新標(biāo)準(zhǔn)和指南 –-研究建議檢測(cè)癥狀前的阿爾茨海默病-新的阿爾茨海默病的定義促使研究者進(jìn)行阿爾茨海默病早期的篩查和干預(yù)-

2011年4月19日，以阿爾茨海默病協(xié)會(huì)和國(guó)立衛(wèi)生院(NIH)的國(guó)家老年研究所(NIA)為先鋒的三個(gè)專家工作組在芝加哥于27年內(nèi)首次發(fā)布了診斷阿爾茨海默病的新標(biāo)準(zhǔn)和指南。

工作組發(fā)行了隨時(shí)可用的4項(xiàng)關(guān)于阿爾茨海默病癡呆和由于阿爾茨海默病導(dǎo)致的輕度認(rèn)知障礙(MCI)的臨床診斷標(biāo)準(zhǔn)。提出的一項(xiàng)研究主題是關(guān)于臨床前的阿爾茨海默病。關(guān)于阿爾茨海默病癡呆和由于阿爾茨海默病導(dǎo)致癡呆的生物標(biāo)記物的使用問(wèn)題僅作為一項(xiàng)研究議題被提出，此次未意圖于其在臨床中的使用。

這些條目-總體而言，國(guó)家老年研究所/阿爾茨海默病協(xié)會(huì)阿爾茨海默病診斷指南-擴(kuò)展阿爾茨海默病定義使其包括此病的兩個(gè)新的階段：①臨床癥狀前和②輕度的癥狀但尚處于癡呆前的階段以及③由阿爾茨海默病導(dǎo)致的失智癥。這反映了當(dāng)前的這樣的觀點(diǎn)：阿爾茨海默病患者在記憶和思維癥狀出現(xiàn)以前的數(shù)十年里腦中可以先產(chǎn)生明顯的可測(cè)量的變化。

阿爾茨海默病協(xié)會(huì)首席官員，哲學(xué)博士William Thies 說(shuō)：“我們希望過(guò)去四分之一世紀(jì)里科學(xué)技術(shù)所取得的進(jìn)步將有助于提高目前的診斷，帶動(dòng)這個(gè)領(lǐng)域的更早的檢查和治療，最終導(dǎo)致有效的病性改善療法”，“這些條目的發(fā)展和出版是這個(gè)領(lǐng)域的重要的里程碑。也就是說(shuō)，這些條目的發(fā)展和出版不是新的阿爾茨海默病診斷標(biāo)準(zhǔn)發(fā)展過(guò)程的結(jié)束，而是這個(gè)過(guò)程中重要的一步”。

國(guó)家健康協(xié)會(huì)的阿爾茨海默病中心項(xiàng)目的項(xiàng)目總監(jiān)，哲學(xué)博士Creighton Phelps說(shuō)“新的指南反映了時(shí)下關(guān)于腦中導(dǎo)致阿爾茨海默病的關(guān)鍵病理變化和他們與輕度認(rèn)知障礙及阿爾茨海默病失智癥的臨床體征之間的關(guān)系”，“我們已經(jīng)可以在臨床癥狀出現(xiàn)前的階段對(duì)這些病理改變進(jìn)行檢測(cè)，許多病人在此后很久才出現(xiàn)臨床癥狀。如新指南中所述，隨著關(guān)于生物標(biāo)記物的進(jìn)一步的研究，我們將最終可以預(yù)測(cè)哪些人具有發(fā)展為輕度認(rèn)知障礙和阿爾茨海默病癡呆的危險(xiǎn)，以及哪些人可以從干預(yù)措施的發(fā)展中獲益最多”。

所推薦的新的阿爾茨海默病指南今天由阿爾茨海默病協(xié)會(huì)主辦雜志Alzheimer’s & Dementia在線出版。紙質(zhì)版已安排在此雜志的2011年的5月份出版。

阿爾茨海默病的三個(gè)分期
目前的阿爾茨海默病的診斷標(biāo)準(zhǔn)通常確定診斷依賴于當(dāng)個(gè)人、家庭或是朋友注意到其在思考、學(xué)習(xí)和記憶方面的癥狀。但是研究告訴我們，阿爾茨海默病可能在患者出現(xiàn)癥狀前數(shù)年甚至是數(shù)十年已經(jīng)開(kāi)始發(fā)病。

新的條目涉及阿爾茨海默病隨著時(shí)間推移發(fā)展的三個(gè)階段：
●阿爾茨海默病臨床前-可測(cè)量的生物標(biāo)記物（譬如腦部影像學(xué)和腦脊液化學(xué)檢測(cè)）的變化在外部的癥狀可見(jiàn)之前表明疾病最早階段的征象。目前沒(méi)有這個(gè)階段的臨床診斷標(biāo)準(zhǔn)，但是工作組提供了一個(gè)科學(xué)的框架幫助研究者更好的定義阿爾茨海默病的這個(gè)階段。（見(jiàn)附錄5.）。
●由于阿爾茨海默病導(dǎo)致的輕度認(rèn)知障礙-在記憶和思考能力方面的輕微的變化，足以被注意和評(píng)估，但是損害還不至于影響日?；顒?dòng)和功能。
●由阿爾茨海默病導(dǎo)致的失智癥-記憶、思考和行為癥狀損害到病人的日常生活的軀體功能。
（更多的細(xì)節(jié)詳見(jiàn)附錄3）

為了將來(lái)便于對(duì)阿爾茨海默病進(jìn)行癥狀前治療，作者認(rèn)為對(duì)疾病最早期的腦的改變進(jìn)行定義是很重要的，不只是疾病可以看見(jiàn)的、有癥狀的階段。作者提出在阿爾茨海默病開(kāi)始階段伴隨著一個(gè)長(zhǎng)時(shí)期的非癥狀的階段，在此階段腦中有害的變化在進(jìn)展，具有這些變化的生物標(biāo)記物證據(jù)的個(gè)體發(fā)展為認(rèn)知和行為損害的風(fēng)險(xiǎn)及進(jìn)展為阿爾茨海默病癡呆的風(fēng)險(xiǎn)在增加。

生物標(biāo)記物是自然發(fā)生，可以測(cè)量的物質(zhì)，或者說(shuō)是人體內(nèi)可以可靠的表明疾病存在與否或之后發(fā)展為疾病的風(fēng)險(xiǎn)的狀況。例如，血糖水平是糖尿病的生物標(biāo)記物，膽固醇水平是心血管疾病風(fēng)險(xiǎn)的生物標(biāo)記物。體液和影像學(xué)檢測(cè)均被檢測(cè)作為阿爾茨海默病的可能的生物標(biāo)記物。（見(jiàn)附錄4）

因?yàn)樯飿?biāo)記物在新近出版發(fā)行的文章中被提出，所以工作組內(nèi)取得了廣泛一致的同意，都認(rèn)為需要更多的研究去驗(yàn)證其應(yīng)用。根據(jù)作者的觀點(diǎn)：“決定性的研究……有可能需要十年去完成實(shí)現(xiàn)。因此，我們必須快速的行動(dòng)……并且因?yàn)樾碌臄?shù)據(jù)已經(jīng)可用所以我們必須調(diào)整我們的模型和研究設(shè)計(jì)”。

Thies 說(shuō)：“如果我們可以最終判定那些具有腦部改變的生物標(biāo)記物的證據(jù)而沒(méi)有外在癥狀表現(xiàn)的具有發(fā)展為阿爾茨海默病癡呆的人群的風(fēng)險(xiǎn)，一旦他們的病情發(fā)展，我們將可以打開(kāi)一個(gè)用病性改善療法干預(yù)的機(jī)會(huì)的重要的窗口”。

“另外，新的標(biāo)準(zhǔn)給了我們強(qiáng)有力的工具去加速我們與阿爾茨海默病戰(zhàn)斗的知識(shí)的更新。他們給予我們一個(gè)關(guān)于阿爾茨海默病流行情況的更精確的評(píng)估的指南。這樣我們可以更好的評(píng)估包括護(hù)理、病人和照料者教育資料、療養(yǎng)院床位、需要的老年病學(xué)專家及護(hù)士等等相關(guān)各種費(fèi)用。并且，他們給我們提供了關(guān)于創(chuàng)造在其各個(gè)階段均有效的下一代阿爾茨海默病治療方法的基礎(chǔ)”。

目標(biāo)轉(zhuǎn)向阿爾茨海默性的更早的診斷和治療
阿爾茨海默病協(xié)會(huì)在其2010年擬題為：“改變阿爾茨海默病的軌跡：一個(gè)國(guó)家的需要”的報(bào)告表明假設(shè)干預(yù)可以將阿爾茨海默病的發(fā)病向后推遲5年，則在2050年可以將阿爾茨海默病患者的數(shù)量減少將近45%，并且將阿爾茨海默病的計(jì)劃的醫(yī)療費(fèi)用由6270億美元減少到3440億美元?！?br>
新發(fā)行的論文的作者寫(xiě)道：“我們希望阿爾茨海默病臨床前得檢測(cè)的進(jìn)步可以有助于更早更有效的治療，就像最近腫瘤、心血管疾病、骨質(zhì)疏松癥、糖尿病在臨床出現(xiàn)顯著癥狀前幾乎所有的治療方面的有益進(jìn)展。其他疾病篩查和治程序的實(shí)施已經(jīng)可以減少這些疾病的死亡率”。

Thies補(bǔ)充說(shuō)：“目前，阿爾茨海默病治療的進(jìn)步可能可以減慢或者是阻止疾病的進(jìn)展。通過(guò)提高早期的檢測(cè)和風(fēng)險(xiǎn)評(píng)估，我們可以更好的檢驗(yàn)潛在的治療方法并且最終可以將他們處方給那些發(fā)病風(fēng)險(xiǎn)不斷增加的患者。基本上這些為阿爾茨海默病設(shè)想的方法在目前的心血管疾病中是很常見(jiàn)的，在心血管疾病中，諸如基因標(biāo)志物或血漿膽固醇和/或血壓水平等早期的風(fēng)險(xiǎn)征象可以被治療，由此可以減少心臟病發(fā)作或者是之后的卒中發(fā)作的可能性?！?br>
對(duì)于阿爾茨海默病的挑戰(zhàn)是目前沒(méi)有單獨(dú)的、可以普遍接受的方法去在疾病癥狀出現(xiàn)之前的最早期識(shí)別它。希望新的臨床前的阿爾茨海默病的文章所概述的研究主題可以糾正這個(gè)缺點(diǎn)。

癥狀發(fā)生前的疾病的檢測(cè)和治療-除了在阿爾茨海默病，已經(jīng)不是一個(gè)什么新思路

據(jù)作者所講：“一個(gè)疾病臨床前階段的概念不應(yīng)該與疾病太不相關(guān)。醫(yī)學(xué)專家容易接受癌癥可以在‘原位癌’的階段被檢測(cè)到和高膽固醇血癥及動(dòng)脈粥樣硬化可以導(dǎo)致冠狀動(dòng)脈狹窄而冠狀動(dòng)脈狹窄可以在心肌梗塞之前被檢測(cè)到的觀點(diǎn)。癥狀并非診斷疾病的必要條件的觀點(diǎn)已經(jīng)被公認(rèn)。2型糖尿病、高血壓、腎功能不全和骨質(zhì)疏松癥常是通過(guò)實(shí)驗(yàn)室檢測(cè)被發(fā)現(xiàn)，有效的治療可以阻止疾病癥狀的出現(xiàn)?！?br>
作者寫(xiě)道：“我們應(yīng)該接受阿爾茨海默病有一天可以通過(guò)生物標(biāo)記物出現(xiàn)的證據(jù)在臨床前被診斷，而這將最終可引導(dǎo)在疾病癥狀出現(xiàn)前進(jìn)行治療。我們治療糖尿病、高膽固醇血癥、高血壓和很多其他疾病的患者，而不是等到一定要出現(xiàn)受這些疾病影響而發(fā)生卒中、心臟病發(fā)作或者其他長(zhǎng)期的并發(fā)癥出現(xiàn)時(shí)才進(jìn)行治療。同樣的，我們的目的是運(yùn)用這些標(biāo)準(zhǔn)去更好的判定一個(gè)人發(fā)展為阿爾茨海默病的風(fēng)險(xiǎn)。這個(gè)診斷將有助于我們發(fā)現(xiàn)將來(lái)的藥物并且為我們能夠把他們使用于有風(fēng)險(xiǎn)的病人以阻止或者推遲癥狀的出現(xiàn)的這么一天做準(zhǔn)備?！?br>
已經(jīng)出版發(fā)行的內(nèi)容
推薦的新的阿爾茨海默病的診斷標(biāo)準(zhǔn)和研究主題通過(guò)三個(gè)文檔提供，還包括一份引言。
●由于阿爾茨海默病的緣故一個(gè)工作組于1984年更新了癡呆的診斷標(biāo)準(zhǔn)。美國(guó)約翰斯·霍普金斯大學(xué)的醫(yī)學(xué)博士Guy McKhann，明尼蘇達(dá)州羅徹斯特市梅約醫(yī)學(xué)中心的醫(yī)學(xué)博士Baltimore和David 共同主持了這項(xiàng)工作。
●第二個(gè)工作組專注于對(duì)癥狀性的、癡呆前階段，即由于阿爾茨海默病導(dǎo)致的所謂的輕度認(rèn)知功能障礙的標(biāo)準(zhǔn)改善工作。

●第三個(gè)工作組提出了一個(gè)關(guān)于阿爾茨海默病的非癥狀性的、臨床前階段的研究主題（不是用于臨床診斷的標(biāo)準(zhǔn)；這是一項(xiàng)重要的區(qū)別。見(jiàn)附錄4.）
●引言部分對(duì)1984年第一個(gè)診斷標(biāo)準(zhǔn)發(fā)行后的阿爾茨海默病領(lǐng)域發(fā)生的變化進(jìn)行了綜述，并勾勒了將來(lái)必須解決的挑戰(zhàn)。

初步的推薦規(guī)范在2010年7月的阿爾茨海默病協(xié)會(huì)主辦的國(guó)際阿爾茨海默病會(huì)議中宣布。這些早期的草稿之后可在阿爾茨海默病協(xié)會(huì)的網(wǎng)站中進(jìn)行評(píng)論，并且還在各種醫(yī)學(xué)和科學(xué)會(huì)中中進(jìn)行了展示和討論。

推薦規(guī)范的三個(gè)部分與當(dāng)前的臨床實(shí)踐不同。
阿爾茨海默病和由于阿爾茨海默病導(dǎo)致的癡呆的臨床診斷標(biāo)準(zhǔn)是為了引導(dǎo)目前背景下的診斷，譬如在醫(yī)生的辦公室，也包括在無(wú)法測(cè)得病人的生物標(biāo)記物的環(huán)境中使用。在這里生物標(biāo)記物在阿爾茨海默病和由于阿爾茨海默病導(dǎo)致的癡呆中只是用于研究。然而，一些生物標(biāo)記物，特別是那些使用先進(jìn)的影像學(xué)技術(shù)的，可以進(jìn)入臨床實(shí)踐在不遠(yuǎn)的將來(lái)，盡管許多仍需要研究他們?cè)诖饲闆r中的實(shí)用性。臨床前阿爾茨海默病的推薦規(guī)范目的只是用于研究，并且在此時(shí)并沒(méi)有臨床實(shí)用性。
已經(jīng)組織了第四個(gè)工作組對(duì)事后析誤和阿爾茨海默病的病理標(biāo)準(zhǔn)進(jìn)行檢驗(yàn)。他們商議的結(jié)果將有望與2011年年內(nèi)的稍后公布。

NEW CRITERIA AND GUIDELINES FOR THE DIAGNOSIS OF ALZHEIMER’S DISEASE PUBLISHED FOR FIRST TIME IN 27 YEARS 27年內(nèi)首次出版發(fā)行的阿爾茨海默病診斷的新標(biāo)準(zhǔn)和指南 - Research Agenda Suggested for Detecting Pre-Symptomatic Alzheimer’s –-New Alzheimer’s Definition Moves Researchers Closer to Early Detection and Intervention –-研究建議檢測(cè)癥狀前的阿爾茨海默病-新的阿爾茨海默病的定義促使研究者進(jìn)行阿爾茨海默病早期的篩查和干預(yù)-

CHICAGO, April 19, 2011 – For the first time in 27 years, new criteria and guidelines for the diagnosis of Alzheimer’s disease have been published by three expert workgroups spearheaded by theAlzheimer’s Association and the National Institute on Aging (NIA) of the National Institutes of Health (NIH).
2011年4月19日，以阿爾茨海默病協(xié)會(huì)和國(guó)立衛(wèi)生院(NIH)的國(guó)家老年研究所(NIA)為先鋒的三個(gè)專家工作組在芝加哥于27年內(nèi)首次發(fā)布了診斷阿爾茨海默病的新標(biāo)準(zhǔn)和指南。

The workgroups published four articles including ready-to-use clinical diagnostic criteria for Alzheimer’s disease dementia and mild cognitive impairment (MCI) due to Alzheimer’s. A research agenda was proposed for preclinical Alzheimer’s. The use of biomarkersin Alzheimer’s dementia and MCI due to Alzheimer’s was also proposed as a research agenda only, and is not intended for application in clinical settings at this time.

工作組發(fā)行了隨時(shí)可用的4項(xiàng)關(guān)于阿爾茨海默病癡呆和由于阿爾茨海默病導(dǎo)致的輕度認(rèn)知障礙(MCI)的臨床診斷標(biāo)準(zhǔn)。提出的一項(xiàng)研究主題是關(guān)于臨床前的阿爾茨海默病。關(guān)于阿爾茨海默病癡呆和由于阿爾茨海默病導(dǎo)致癡呆的生物標(biāo)記物的使用問(wèn)題僅作為一項(xiàng)研究議題被提出，此次未意圖于其在臨床中的使用。

The articles – collectively, the National Institute on Aging/Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease – expandthe definition of Alzheimer’s to include two new phases of the disease: (1) presymptomatic and (2) mildly symptomatic but pre-dementia, along with (3)dementia caused by Alzheimer’s. This reflects current thinking that Alzheimer’s begins creating distinct and measurable changes in the brains of affected people years, perhaps decades, before memory and thinking symptoms are noticeable.

這些條目-總體而言，國(guó)家老年研究所/阿爾茨海默病協(xié)會(huì)阿爾茨海默病診斷指南-擴(kuò)展阿爾茨海默病定義使其包括此病的兩個(gè)新的階段：①臨床癥狀前和②輕度的癥狀但尚處于癡呆前的階段以及③由阿爾茨海默病導(dǎo)致的失智癥。這反映了當(dāng)前的這樣的觀點(diǎn)：阿爾茨海默病患者在記憶和思維癥狀出現(xiàn)以前的數(shù)十年里腦中可以先產(chǎn)生明顯的可測(cè)量的變化。

“It is our hope that incorporating scientific knowledge gained and technological advances made over the past quarter century will improve current diagnosis, bring the field closer to earlier detection and treatment, and ultimately lead to effective disease-modifying therapies,” said William Thies, Ph.D., Chief Medical and Scientific Officer at the Alzheimer’s Association. “Development and publication of these articles is a major landmark in the field. That said, publication of these articles is not yet the end of the process of developing new diagnostic criteria for Alzheimer’s, but is another major step in the process.”
阿爾茨海默病協(xié)會(huì)首席官員，哲學(xué)博士William Thies 說(shuō)：“我們希望過(guò)去四分之一世紀(jì)里科學(xué)技術(shù)所取得的進(jìn)步將有助于提高目前的診斷，帶動(dòng)這個(gè)領(lǐng)域的更早的檢查和治療，最終導(dǎo)致有效的病性改善療法”，“這些條目的發(fā)展和出版是這個(gè)領(lǐng)域的重要的里程碑。也就是說(shuō)，這些條目的發(fā)展和出版不是新的阿爾茨海默病診斷標(biāo)準(zhǔn)發(fā)展過(guò)程的結(jié)束，而是這個(gè)過(guò)程中重要的一步”。

“The new guidelines reflect today’s understanding of how key changes in the brain lead to Alzheimer’s disease pathology and how they relate to the clinical signs of mild cognitive impairment and Alzheimer’s disease dementia,” said Creighton Phelps, Ph.D., Program Director of the Alzheimer’s Disease Centers Program at the National Institutes of Health. “We are also beginning to be able to detect these changes at a preclinical stage, long before symptoms appear in many people. With further research on biomarkers, as set forth in the new guidelines, we may ultimately be able to predict who is at risk for development of mild cognitive impairment and Alzheimer’s dementia, and who would benefit most as interventions are developed.”
國(guó)家健康協(xié)會(huì)的阿爾茨海默病中心項(xiàng)目的項(xiàng)目總監(jiān)，哲學(xué)博士Creighton Phelps說(shuō)“新的指南反映了時(shí)下關(guān)于腦中導(dǎo)致阿爾茨海默病的關(guān)鍵病理變化和他們與輕度認(rèn)知障礙及阿爾茨海默病失智癥的臨床體征之間的關(guān)系”，“我們已經(jīng)可以在臨床癥狀出現(xiàn)前的階段對(duì)這些病理改變進(jìn)行檢測(cè)，許多病人在此后很久才出現(xiàn)臨床癥狀。如新指南中所述，隨著關(guān)于生物標(biāo)記物的進(jìn)一步的研究，我們將最終可以預(yù)測(cè)哪些人具有發(fā)展為輕度認(rèn)知障礙和阿爾茨海默病癡呆的危險(xiǎn)，以及哪些人可以從干預(yù)措施的發(fā)展中獲益最多”。

The proposed new Alzheimer’s disease diagnostic guidelines were published online today by Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. Hard copy publication is scheduled for the May 2011 issue of the journal.
所推薦的新的阿爾茨海默病指南今天由阿爾茨海默病協(xié)會(huì)主辦雜志Alzheimer’s & Dementia在線出版。紙質(zhì)版已安排在此雜志的2011年的5月份出版。

Three Stages of Alzheimer’s Disease
阿爾茨海默病的三個(gè)分期
The current diagnostic criteria for Alzheimer’s*, for the most part, focus on reliable diagnosis when signs of problems in thinking, learning, and memory are noticeable to an individual, family, and friends. But research tells us that Alzheimer’s likely begins years, maybe even decades, prior to symptoms appearing.
目前的阿爾茨海默病的診斷標(biāo)準(zhǔn)通常確定診斷依賴于當(dāng)個(gè)人、家庭或是朋友注意到其在思考、學(xué)習(xí)和記憶方面的癥狀。但是研究告訴我們，阿爾茨海默病可能在患者出現(xiàn)癥狀前數(shù)年甚至是數(shù)十年已經(jīng)開(kāi)始發(fā)病。

The new articles refer to three phases of Alzheimer’s disease progression over time:
Preclinical Alzheimer’s Disease– Measurable changes in biomarkers (such as brain imaging and spinal fluid chemistry) that indicate the very earliest signs of disease, before outward symptoms are visible. Currently, there are no clinical diagnostic criteria for this phase, but the group provides a scientific framework to help researchers better define this stage of Alzheimer’s. (See supplement 5.)Mild cognitive impairment (MCI) due to Alzheimer’s Disease– Mild changes in memory and thinking abilities, enough to be noticed and measured, but not impairment that compromises everyday activities and functioning. Dementia due to Alzheimer’s Disease– Memory, thinking and behavioral symptoms that impair a person’s ability to function in daily life. (For more details, see supplement 3.)
新的條目涉及阿爾茨海默病隨著時(shí)間推移發(fā)展的三個(gè)階段：
●阿爾茨海默病臨床前-可測(cè)量的生物標(biāo)記物（譬如腦部影像學(xué)和腦脊液化學(xué)檢測(cè)）的變化在外部的癥狀可見(jiàn)之前表明疾病最早階段的征象。目前沒(méi)有這個(gè)階段的臨床診斷標(biāo)準(zhǔn)，但是工作組提供了一個(gè)科學(xué)的框架幫助研究者更好的定義阿爾茨海默病的這個(gè)階段。（見(jiàn)附錄5.）。
●由于阿爾茨海默病導(dǎo)致的輕度認(rèn)知障礙-在記憶和思考能力方面的輕微的變化，足以被注意和評(píng)估，但是損害還不至于影響日?；顒?dòng)和功能。
●由阿爾茨海默病導(dǎo)致的失智癥-記憶、思考和行為癥狀損害到病人的日常生活的軀體功能。
（更多的細(xì)節(jié)詳見(jiàn)附錄3）

According to the authors, in order to facilitate the possibility of future presymptomatic treatment of Alzheimer’s, it was important to define the disease from the earliest changes in the brain, not only the observable, symptomatic stages of the disease. The authors propose that Alzheimer’s begins with a long asymptomatic period during which detrimental changes are progressing in the brain, and individuals with biomarker evidence of these changes are at increased risk for developing cognitive and behavioral impairment and progression to Alzheimer’s dementia.
為了將來(lái)便于對(duì)阿爾茨海默病進(jìn)行癥狀前治療，作者認(rèn)為對(duì)疾病最早期的腦的改變進(jìn)行定義是很重要的，不只是疾病可以看見(jiàn)的、有癥狀的階段。作者提出在阿爾茨海默病開(kāi)始階段伴隨著一個(gè)長(zhǎng)時(shí)期的非癥狀的階段，在此階段腦中有害的變化在進(jìn)展，具有這些變化的生物標(biāo)記物證據(jù)的個(gè)體發(fā)展為認(rèn)知和行為損害的風(fēng)險(xiǎn)及進(jìn)展為阿爾茨海默病癡呆的風(fēng)險(xiǎn)在增加。

A biomarker is a naturally occurring, measurable substance or condition in the body that reliably indicates the presence or absence of disease or the risk of later developing a disease; for example, blood glucose levels are a biomarker of diabetes, and cholesterol levels are a biomarker of cardiovascular disease risk. Both fluid and imaging measures are being tested as possible biomarkers for Alzheimer’s. (See supplement 4.)
生物標(biāo)記物是自然發(fā)生，可以測(cè)量的物質(zhì)，或者說(shuō)是人體內(nèi)可以可靠的表明疾病存在與否或之后發(fā)展為疾病的風(fēng)險(xiǎn)的狀況。例如，血糖水平是糖尿病的生物標(biāo)記物，膽固醇水平是心血管疾病風(fēng)險(xiǎn)的生物標(biāo)記物。體液和影像學(xué)檢測(cè)均被檢測(cè)作為阿爾茨海默病的可能的生物標(biāo)記物。（見(jiàn)附錄4）

There was a broad consensus within the workgroups that much additional research needs to be done to validate the application of biomarkers as they are proposed in the newly-published articles. According to the authors, “The definitive studies … are likely to take more than a decade to fully accomplish. Thus, we must move quickly … and adjust our models and study designs as new data become available.”
因?yàn)樯飿?biāo)記物在新近出版發(fā)行的文章中被提出，所以工作組內(nèi)取得了廣泛一致的同意，都認(rèn)為需要更多的研究去驗(yàn)證其應(yīng)用。根據(jù)作者的觀點(diǎn)：“決定性的研究……有可能需要十年去完成實(shí)現(xiàn)。因此，我們必須快速的行動(dòng)……并且因?yàn)樾碌臄?shù)據(jù)已經(jīng)可用所以我們必須調(diào)整我們的模型和研究設(shè)計(jì)”。

“If we can definitively determine the risk of developing Alzheimer’s dementia in people who have biomarker evidence of brain changes but are not showing outward symptoms, we will open an important window of opportunity to intervene with disease-modifying therapies, once they are developed,” Thiessaid.
Thies 說(shuō)：“如果我們可以最終判定那些具有腦部改變的生物標(biāo)記物的證據(jù)而沒(méi)有外在癥狀表現(xiàn)的具有發(fā)展為阿爾茨海默病癡呆的人群的風(fēng)險(xiǎn)，一旦他們的病情發(fā)展，我們將可以打開(kāi)一個(gè)用病性改善療法干預(yù)的機(jī)會(huì)的重要的窗口”。

“In addition, the new criteria give us powerful tools to accelerate our knowledge in the fight against Alzheimer’s disease. They give us guidelines for getting a more accurate assessment of Alzheimer’s prevalence. In that way we can better assess the need for everything from research dollars to care services, to patient and caregiver education materials, to nursing home beds, to the number of gerontologists and nurses that we need. And, they give us a basis for creating the next generation of Alzheimer’s treatments that will be effective in each stage of the disease,” Thies said.
“另外，新的標(biāo)準(zhǔn)給了我們強(qiáng)有力的工具去加速我們與阿爾茨海默病戰(zhàn)斗的知識(shí)的更新。他們給予我們一個(gè)關(guān)于阿爾茨海默病流行情況的更精確的評(píng)估的指南。這樣我們可以更好的評(píng)估包括護(hù)理、病人和照料者教育資料、療養(yǎng)院床位、需要的老年病學(xué)專家及護(hù)士等等相關(guān)各種費(fèi)用。并且，他們給我們提供了關(guān)于創(chuàng)造在其各個(gè)階段均有效的下一代阿爾茨海默病治療方法的基礎(chǔ)”。

Moving the Field Toward Earlier Diagnosis and Treatment of Alzheimer’s
目標(biāo)轉(zhuǎn)向阿爾茨海默性的更早的診斷和治療
The Alzheimer’s Association, in its 2010 report titled “Changing the Trajectory of Alzheimer’s Disease: A National Imperative,” showed that a hypothetical intervention that delayed the onset of Alzheimer’s dementia by five years would result in a nearly 45 percent reduction in the number of people with Alzheimer’s by 2050, and reduce the projected Medicare costs of Alzheimer’s from $627 billion to $344 billion dollars.
阿爾茨海默病協(xié)會(huì)在其2010年擬題為：“改變阿爾茨海默病的軌跡：一個(gè)國(guó)家的需要”的報(bào)告表明假設(shè)干預(yù)可以將阿爾茨海默病的發(fā)病向后推遲5年，則在2050年可以將阿爾茨海默病患者的數(shù)量減少將近45%，并且將阿爾茨海默病的計(jì)劃的醫(yī)療費(fèi)用由6270億美元減少到3440億美元。”

The authors of the newly-released articles write, “It is our hope that the advances in preclinical detection of Alzheimer’s will enable earlier, more effective treatment, just as nearly all of therapeutic gains in cancer, cardiovascular disease, osteoporosis, and diabetes involve treatment before significant clinical symptoms are present. Screening and treatment programs instituted for other diseases … have already been associated with a decrease in mortality due to these conditions.”
新發(fā)行的論文的作者寫(xiě)道：“我們希望阿爾茨海默病臨床前得檢測(cè)的進(jìn)步可以有助于更早更有效的治療，就像最近腫瘤、心血管疾病、骨質(zhì)疏松癥、糖尿病在臨床出現(xiàn)顯著癥狀前幾乎所有的治療方面的有益進(jìn)展。其他疾病篩查和治程序的實(shí)施已經(jīng)可以減少這些疾病的死亡率”。

Thiesadds, “Currently, Alzheimer’s therapies are in development that may be able to slow or stop the progression of the disease. By improving early detection and risk evaluation, we will better be able to test potential therapies and eventually prescribe them for people at increased risk. Ultimately, this approach envisions for Alzheimer’s what is now common practice in cardiovascular disease, where early signs of risk – for example, in genetic markers or in blood cholesterol and/or blood pressure levels – can be treated to reduce the likelihood of heart attack or stroke later on.”
Thies補(bǔ)充說(shuō)：“目前，阿爾茨海默病治療的進(jìn)步可能可以減慢或者是阻止疾病的進(jìn)展。通過(guò)提高早期的檢測(cè)和風(fēng)險(xiǎn)評(píng)估，我們可以更好的檢驗(yàn)潛在的治療方法并且最終可以將他們處方給那些發(fā)病風(fēng)險(xiǎn)不斷增加的患者?；旧线@些為阿爾茨海默病設(shè)想的方法在目前的心血管疾病中是很常見(jiàn)的，在心血管疾病中，諸如基因標(biāo)志物或血漿膽固醇和/或血壓水平等早期的風(fēng)險(xiǎn)征象可以被治療，由此可以減少心臟病發(fā)作或者是之后的卒中發(fā)作的可能性?！?br>
The challenge for Alzheimer’s now is that there is currently no single, generally accepted way to identify the disease in the earliest stage – before symptoms are evident. It is hoped that the research agenda outlined in the new preclinical Alzheimer’s article will correct this deficit.
對(duì)于阿爾茨海默病的挑戰(zhàn)是目前沒(méi)有單獨(dú)的、可以普遍接受的方法去在疾病癥狀出現(xiàn)之前的最早期識(shí)別它。希望新的臨床前的阿爾茨海默病的文章所概述的研究主題可以糾正這個(gè)缺點(diǎn)。

Presymptomatic Disease Detection and Treatment – Not a New Idea, Except in Alzheimer’s
癥狀發(fā)生前的疾病的檢測(cè)和治療-除了在阿爾茨海默病，已經(jīng)不是一個(gè)什么新思路

According to the authors, “The concept of a preclinical phase of disease should not be too foreign. Medical professionals readily acknowledge that cancer can be detected at the stage of ‘carcinoma in situ’ and that hypercholesterolemia and atherosclerosis can result in narrowing of coronary arteries that is detectable prior to myocardial infarction. It is widely acknowledged that symptoms are not necessary to diagnose human disease. Type II diabetes, hypertension, renal insufficiency, and osteoporosis are frequently detected through laboratory tests, and effective treatment can prevent the emergence of symptoms.”
據(jù)作者所講：“一個(gè)疾病臨床前階段的概念不應(yīng)該與疾病太不相關(guān)。醫(yī)學(xué)專家容易接受癌癥可以在‘原位癌’的階段被檢測(cè)到和高膽固醇血癥及動(dòng)脈粥樣硬化可以導(dǎo)致冠狀動(dòng)脈狹窄而冠狀動(dòng)脈狹窄可以在心肌梗塞之前被檢測(cè)到的觀點(diǎn)。癥狀并非診斷疾病的必要條件的觀點(diǎn)已經(jīng)被公認(rèn)。2型糖尿病、高血壓、腎功能不全和骨質(zhì)疏松癥常是通過(guò)實(shí)驗(yàn)室檢測(cè)被發(fā)現(xiàn)，有效的治療可以阻止疾病癥狀的出現(xiàn)?！?br>
“We should be open to the idea that Alzheimer’s could one day be diagnosed preclinically by the presence of biomarker evidence, which may eventually guide therapy prior to the onset of symptoms. We treat people with diabetes, elevated cholesterol, hypertension and a variety of other illnesses – we do not wait for strokes, heart attacks or other long term complications that we know will occur in significant numbers of those affected. Similarly, our intention is to use these criteria to better determine an individual’s risk of developing Alzheimer’s disease. This diagnostic research will help us discover the drugs of the future and prepare for the day when we can administer them to those at risk in order to prevent or delay the emergence of symptoms,” wrote the authors.
作者寫(xiě)道：“我們應(yīng)該接受阿爾茨海默病有一天可以通過(guò)生物標(biāo)記物出現(xiàn)的證據(jù)在臨床前被診斷，而這將最終可引導(dǎo)在疾病癥狀出現(xiàn)前進(jìn)行治療。我們治療糖尿病、高膽固醇血癥、高血壓和很多其他疾病的患者，而不是等到一定要出現(xiàn)受這些疾病影響而發(fā)生卒中、心臟病發(fā)作或者其他長(zhǎng)期的并發(fā)癥出現(xiàn)時(shí)才進(jìn)行治療。同樣的，我們的目的是運(yùn)用這些標(biāo)準(zhǔn)去更好的判定一個(gè)人發(fā)展為阿爾茨海默病的風(fēng)險(xiǎn)。這個(gè)診斷將有助于我們發(fā)現(xiàn)將來(lái)的藥物并且為我們能夠把他們使用于有風(fēng)險(xiǎn)的病人以阻止或者推遲癥狀的出現(xiàn)的這么一天做準(zhǔn)備?！?br>What Was Published
The proposed new diagnostic criteria and research agenda for Alzheimer’s disease are presented in three documents, plus an introduction.
One workgroup updated the 1984 diagnostic criteria for the dementia due to Alzheimer’s disease. Guy McKhann, M.D., Johns Hopkins University School of Medicine, Baltimore, and David Knopman, M.D., Mayo Clinic, Rochester, Minn., co-chaired this panel.A second workgroup focused on refining the criteria for the symptomatic, pre-dementia phase, referred to as Mild Cognitive Impairment due to Alzheimer’s disease. Marilyn Albert, Ph.D., Johns Hopkins University School of Medicine, Baltimore, chaired this workgroup.The third workgroup proposed a research agenda (NOT criteria for clinical diagnosis; this is an important distinction. See supplement 4.) for the asymptomatic, preclinical phase of Alzheimer’s. Reisa Sperling, M.D, Brigham and Women's Hospital, Harvard Medical School, Boston, chaired this group.The introduction provides an overview of the changes that have occurred in the Alzheimer’s field since the first diagnostic criteria were published in 1984, and outlines future challenges that need to be addressed. Clifford Jack, M.D., Mayo Clinic, Rochester, Minn., is lead author of this article. 已經(jīng)出版發(fā)行的內(nèi)容
推薦的新的阿爾茨海默病的診斷標(biāo)準(zhǔn)和研究主題通過(guò)三個(gè)文檔提供，還包括一份引言。
●由于阿爾茨海默病的緣故一個(gè)工作組于1984年更新了癡呆的診斷標(biāo)準(zhǔn)。美國(guó)約翰斯·霍普金斯大學(xué)的醫(yī)學(xué)博士Guy McKhann，明尼蘇達(dá)州羅徹斯特市梅約醫(yī)學(xué)中心的醫(yī)學(xué)博士Baltimore和David 共同主持了這項(xiàng)工作。
●第二個(gè)工作組專注于對(duì)癥狀性的、癡呆前階段，即由于阿爾茨海默病導(dǎo)致的所謂的輕度認(rèn)知功能障礙的標(biāo)準(zhǔn)改善工作。

●第三個(gè)工作組提出了一個(gè)關(guān)于阿爾茨海默病的非癥狀性的、臨床前階段的研究主題（不是用于臨床診斷的標(biāo)準(zhǔn)；這是一項(xiàng)重要的區(qū)別。見(jiàn)附錄4.）
●引言部分對(duì)1984年第一個(gè)診斷標(biāo)準(zhǔn)發(fā)行后的阿爾茨海默病領(lǐng)域發(fā)生的變化進(jìn)行了綜述，并勾勒了將來(lái)必須解決的挑戰(zhàn)。

Preliminary recommendations were announced in July 2010 at the Alzheimer’s Association International Conference on Alzheimer’s Disease (AAICAD). These early drafts were then made available for comment on the Alzheimer’s Association website, along with further presentation and discussion at a variety of medical and scientific meetings.
初步的推薦規(guī)范在2010年7月的阿爾茨海默病協(xié)會(huì)主辦的國(guó)際阿爾茨海默病會(huì)議中宣布。這些早期的草稿之后可在阿爾茨海默病協(xié)會(huì)的網(wǎng)站中進(jìn)行評(píng)論，并且還在各種醫(yī)學(xué)和科學(xué)會(huì)中中進(jìn)行了展示和討論。
The three sets of recommendations differ in terms of relevance to current clinical practice.
The clinical diagnostic criteria for Alzheimer’s dementia and MCI due to Alzheimer’s are intended to guide diagnosis in the current clinical setting, such as a doctor’s office, including settings where no access to testing for biomarkers exists.The use of biomarkers in both Alzheimer’s dementia and MCI due to Alzheimer’s disease is intended only for research at this time. However, some biomarkers, especially those using advanced imaging techniques, could enter clinical practice in the near future, though much remains to be learned about their utility in this setting.The recommendations of the preclinical Alzheimer’s workgroup are intended for research purposes only, and do not have any clinical utility at this time.
A fourth workgroup has been organized to examine the postmortem, pathological criteria for Alzheimer’s. The results of their deliberations are expected to appear later in 2011.
推薦規(guī)范的三個(gè)部分與當(dāng)前的臨床實(shí)踐不同。
阿爾茨海默病和由于阿爾茨海默病導(dǎo)致的癡呆的臨床診斷標(biāo)準(zhǔn)是為了引導(dǎo)目前背景下的診斷，譬如在醫(yī)生的辦公室，也包括在無(wú)法測(cè)得病人的生物標(biāo)記物的環(huán)境中使用。在這里生物標(biāo)記物在阿爾茨海默病和由于阿爾茨海默病導(dǎo)致的癡呆中只是用于研究。然而，一些生物標(biāo)記物，特別是那些使用先進(jìn)的影像學(xué)技術(shù)的，可以進(jìn)入臨床實(shí)踐在不遠(yuǎn)的將來(lái)，盡管許多仍需要研究他們?cè)诖饲闆r中的實(shí)用性。臨床前阿爾茨海默病的推薦規(guī)范目的只是用于研究，并且在此時(shí)并沒(méi)有臨床實(shí)用性。