Abstract:

The concept of subjective cognitive decline (SCD) is currently receiving much attention, as SCD has a high risk of transitioning to mild cognitive impairment (MCI) and dementia.The ATN biomarker diagnostic framework can accurately diagnose SCD as preclinical Alzheimer's disease (AD), which is an important window for precise prevention and treatment of AD.Based on the present diagnostic paradigms of clinical diagnosis and biomarker diagnosis for SCD, it is important to have fine management during the diagnostic process and precise communication and support after diagnosis for SCD patients, including diagnostic management specification, interpretation and recommendation diagnostic of biomarker disclosure, patients health management, and possible treatment for specific underlying causes.Previous studies have shown heterogeneity between clinical research and practice, and many doctors still feel unfamiliar with the concept of SCD and lack a systematic understanding.SCD diagnosis can provide patients with a certain degree of certainty, but it may also bring uncertainty about the expected risk of disease, and there is an urgent need to provide guidance to clinical doctors.So far, there is still a lack of Chinese expert consensus on diagnostic management specification, biomarker disclosure, and patient management of SCD.Based on the systematic summary of the current domestic and international research on the SCD, the consensus is written and aimed to improve the diagnosis and treatment level of SCD, guide high-quality preclinical AD research and lay the foundation for further clinical translation.

Key words: Cognition disorders, Alzheimer disease, Biomarkers, Diagnostic and treatment guideline

摘要：

“主观认知下降”的概念备受关注，具有向轻度认知障碍和痴呆转化的高风险。ATN诊断框架可以将临床诊断的主观认知下降精准诊断为阿尔茨海默病临床前期，是阿尔茨海默病精准预防与治疗的重要窗口。基于目前主观认知下降的临床诊断与生物学标志物诊断两种诊断范式，疾病规范管理以及诊断后精准沟通与支持十分重要，包括诊断管理规范、生物学标志物结果解读及建议、患者健康管理及可能针对特定潜在病因的治疗等。既往临床研究与临床实践存在异质性，很多临床医师对“主观认知下降”的概念仍感陌生，缺乏系统认识；主观认知下降的诊断可给患者提供一定的确定性，也可带来疾病预期风险的不确定性，迫切需要对临床医师进行指导。迄今国内尚缺乏主观认知下降的诊断管理规范、生物学标志物披露与患者管理的指南或共识。鉴于此，本文在系统梳理国内外相关文献的基础上，撰写《主观认知下降的诊断管理规范与生物学标志物披露流程专家共识》，以期提高我国医务人员对主观认知下降的认识及诊断与治疗水平，指导开展高质量的阿尔茨海默病临床前期研究，为进一步临床转化奠定基础。

关键词: 认知障碍, 阿尔茨海默病, 生物标记, 诊疗指南