The neuropathological and cognitive changes preceding Alzheimer's disease (AD) appear to begin decades before disease symptoms make the clinical diagnosis obvious. Clinical trials have begun to focus on preventive treatments aimed to slow cognitive decline in people with only subjective memory complaints. However, it is not clear how many years before clinical diagnosis of Alzheimer's disease is possible to recognize early signs of neurodegeneration. We report evidence from the literature showing feasibility to diagnose AD at the stage of mild cognitive impairment (MCI) and also a few years before the MCI stage with imaging markers. However, we showed that neuroimaging brain changes evidenced decades before MCI are not early signs of neurodegeneration but expression of genetic risk states for AD or markers of inter-individual variability of cognitive performance due to genetic or environmental factors.

译文

阿尔茨海默病 (AD) 之前的神经病理和认知变化似乎在疾病症状使临床诊断变得明显之前的几十年就开始了。临床试验已经开始集中于预防性治疗,旨在减缓只有主观记忆主诉的人的认知能力下降。但是,尚不清楚在阿尔茨海默氏病的临床诊断之前有多少年可以识别神经变性的早期迹象。我们报告了文献中的证据,表明在轻度认知障碍 (MCI) 阶段以及在MCI阶段之前几年使用成像标记物诊断AD的可行性。然而,我们发现,在MCI之前数十年,神经影像学的大脑变化证明不是神经变性的早期迹象,而是AD的遗传风险状态的表达或由于遗传或环境因素导致的认知表现的个体间变异性的标记。

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