神经科学进展认知功能障碍课件.pptVIP

认知功能障碍诊断、治疗新观念 阿尔茨海默病（Alzheimer’s disease） AD (AD-P AD-C) 的新理念、诊断新指南NIA2011 AD研究热点 AD治疗及预防新进展 血管性认知功能障碍（Vascular Cognitive Impairment） FTDP-17病例报道 Diagnosis of AD:  High accuracy, at earliest stage Revising AD definition “dual clinicopathological entity” (1) 临床表型：a progressive dementia episodic memory impairment as a defining feature and involvement of other cognitive domains or skills, (2) 特异的神经病理改变 intraneuronal (neurofibrillary tangles), extracellular parenchymal lesions (senile plaques), synaptic loss and vascular amyloid deposits. AD “双重临床生物学实体”: in-vivo biological evidence of Alzheimer’s pathology AD两个临床阶段: AD-P and AD-C AD-P: AD-pathophysiological process AD-C: Clinical phases of AD as “AD-Clinical” including not only AD dementia, but also MCI due to AD-P Between AD-P and AD-C Time lag: 10 yrs or more (evidence: genetic at-risk and aging cohorts) Extent of biomarkers as predictor? Modulate the relationship between AD-P and AD-C “a specific threshold or regional distribution of AD pathology, and/or a specific combination of biomarker abnormalities” remains unknown To be clarified AD could one day be diagnosed preclinically by the presence of biomarker evidence of AD-P, which may eventually guide therapy before the onset of symptoms. The hypothesis that many individuals with laboratory evidence of AD-P are indeed in the preclinical stages of AD, and determine which biomarker and cognitive profiles are most predictive of subsequent clinical decline and emergence of AD-C. New Research Criteria framework for the Diagnosis of AD 新：病理生理标记物适用于各阶段的AD 新：AD传统的单一的临床实体转化为双重的临床和病理 实体的结合 新：AD的诊断是临床伴活体病理肯定的诊断，不再是可能 或很可能的单一的临床诊断，尸检只用于验证诊断 A new lexicon for Alzheimer’s disease AD涉及两个临床阶段: 前驱期AD and AD dementia 前驱期AD = memo+, bio+，无痴呆，一定进展为ADD 临床前期AD： 无症状AD的危险状态:不诊断AD，(memo-, bio+)，无AD症状，条件转化为AD 症状前期＝不诊断AD，(memo-, bio-)，无AD症状，有AD单基因突变 MCI ＝不诊断AD，(memo-, bio-)，无AD症状，不一定转化为AD New Research Criteria framework for the Diagnosis of AD AD dementia phase: Typical