AD临床前期SCD作为AD防治的重要关口，应得到充分的重视。然而由于我国的AD研究起步较晚，很多神经科、老年科及精神科医师对SCD这一提法、概念感到相当地陌生，缺乏系统的认识，对AD的印象还停留在痴呆期。因此我们急需加强对SCD相关知识的普及和诊断流程的规范。本共识坚持“可操作性第一”的原则，对SCD的兴起背景、SCD概念、病史询问、体格检查、神经心理评估量表、辅助检查、影像扫描进行了系统的介绍，尤其对神经心理评估量表和影像数据采集提供了切实可用的界值和参数，无疑将极大地促进我国医务人员对SCD的认知及其诊断的标准化和规范化，为实现“健康中国2030”这一宏伟目标贡献力量。
图1 ：
SCD诊断流程图
缩写：MCI: mild cognitive decline, 轻度认知障碍;NC：normal control,
正常对照;SCD：subjective cognitive decline, 主观认知下降;AD：Alzheimer’ disease, 阿尔茨海默病
执笔
： 陈观群、王晓妮、王培昌
专家委员会成员
：(按姓氏汉语拼音排序)
蔡彦宁(首都医科大学宣武医院)、陈瑛(首都医科大学宣武医院)、崔碧霄(首都医科大学宣武医院)、杜文莹(首都医科大学宣武医院)、冯凯(北京市顺义区医院)、Frank
Jessen(德国科隆大学医院)、高家红(北京大学)、郭起浩(复旦大学附属华山医院)、郝立晓(首都医科大学宣武医院)、韩璎(首都医科大学宣武医院)、贺永(北京师范大学)、胡笑晨(德国科隆大学医院)、李嘉辰(首都医科大学宣武医院)、李轩宇(首都医科大学宣武医院)、李延峰(北京协和医院)、卢洁(首都医科大学宣武医院)、门卫伟(北京大学)、穆斌(首都医科大学宣武医院)、孙宇(首都医科大学宣武医院)、王培昌(首都医科大学宣武医院)、王小琪(首都医科大学宣武医院)、汪子琪(首都医科大学宣武医院)、许贤豪(北京医院)、杨柳(首都医科大学宣武医院)、张玲(首都医科大学)、赵维纳(首都医科大学宣武医院)、左西年(中科院心理所)
参考文献：
[1] Sabayan B, Sorond F. Reducing Risk ofDementia in Older Age[J].
JAMA,2017,317(19):2028. DOI: 10.1001/jama.2017.2247
[2] 潘晓东，陈晓春. 阿尔茨海默病的治疗——路在何方[J].
中华神经科杂志,2017,50(5):323-325.DOI:10.3760/cma.j.issn.1006-7876.2017.05.002
[3] Egan, M.F, Kost, J, Voss, T et al., Randomized Trial of Verubecestat
for Prodromal Alzheimer's Disease. N Engl J Med, 2019. 380(15): p.
1408-1420.
[4] Long, J.M. and D.M. Holtzman, Alzheimer Disease: An Update on
Pathobiology and Treatment Strategies. Cell, 2019. 179(2): p. 312-339.
[5] Fan D, Wang Y. Early Intervention in Alzheimer’sDisease: How Early is
Early Enough? Neurosci. Bul. 2020, 36(2): 195–197.
[6] 韩璎. 解读NIA-AA新理解对于阿尔茨海默病的二级预防理念影响. 医学研究杂志,2014,43(8):1-3.
[7] Pichet Binette A, Vachon-Presseau É, Morris J, et al. Amyloid and Tau
Pathology Associations With Personality Traits, Neuropsychiatric Symptoms, and
Cognitive Lifestyle in the Preclinical Phases of Sporadic and Autosomal Dominant
Alzheimer's Disease. Biol Psychiatry. 2020, doi:
10.1016/j.biopsych.2020.01.023.
[8] Palmqvist S, Janelidze S, Quiroz YT, et al. Discriminative Accuracy of
Plasma Phospho-tau217 for Alzheimer Disease vs Other Neurodegenerative
Disorders. JAMA. 2020, doi: 10.1001/jama.2020.12134.
[9] Jessen F, Amariglio R E, van Boxtel M, etal. A conceptual framework for
research on subjective cognitive decline inpreclinical Alzheimer's disease[J].
Alzheimers Dement,2014,10(6):844-852. DOI:10.1016/j.jalz.2014.01.001
[10] Frank Jessen, Rebecca EAmariglio, Rachel F Buckley, Wiesje M van der
Flier, Ying Han,José Luis Molinuevo, Laura Rabin, Dorene M Rentz, Octavio
Rodriguez-Gomez,Andrew J Saykin, Sietske A M Sikkes, Colette M Smart, Steffen
Wolfsgruber,Michael Wagner. The characterisation of subjective cognitive
decline. Lancet Neurology. 2020,Mar;19(3). DOI: 10.1016/
S1474-4422(19)30368-0.
[11] XiaoqiWang#, Weijie Huang #, Li Su, Yue Xing, Frank Jessen, Yu Sun*,
Ni Shu*,Ying Han*. Neuroimagingadvances regarding subjective cognitive decline
in preclinical Alzheimer’sdisease. Molecular Neurodegeneration. 2020.
[12]
孙宇,王晓妮,陈观群,盛灿,李轩宇,杨勤,李陶然,杜文莹,王小琪,林立,刘奕,冯逢,胡笑晨,韩璎*.解读LancetNeurology发表的主观认知下降的特征[J].中华神经科杂志,2020,53(5):396-401.DOI:10.3760/cma.j.cn113694-20191221-00802
[13] Can Sheng*, Kun Yang, Xiaoni Wang, Hongyan Li, Taoran Li, Li Lin, Yi
Liu, Qin Yang,Xiaoqi Wang, Xue Wang*, Yu Sun*, Ying Han*. Advances
inNon-Pharmacological Interventions for Subjective Cognitive Decline:
Asystematic Review and Meta-Analysis. J Alzheimers Dis. 2020 Jul 25.
doi:10.3233/JAD-191295.
[14] Wolfsgruber, S., Laske, C,Buchmann, M et al., Minor neuropsychological
deficits in patients with subjective cognitive decline. Neurology, 2020.Rabin L
A, Smart C M, Crane PK, et al. Subjective Cognitive Decline in Older Adults: An
Overview of Self-Report Measures Used Across 19 International Research
Studies[J]. JAlzheimers Dis,2015,48 Suppl 1:S63-S86. DOI:10.3233/JAD-150154
[15] 赵一鸣，曾琳，李楠，等. 试论临床医学协同研究[J].
中华医学杂志,2017,97(12):890-893.DOI:10.3760/cma.j.issn.0376-2491.2017.12.003
[16] Molinuevo J L, Rabin L A,Amariglio R, et al. Implementation of
subjective cognitive decline criteria inresearch studies[J]. Alzheimers
Dement,2017,13(3):296-311. DOI:10.1016/ j.jalz.2016.09. 012
[17] Jessen F, Spottke A, Boecker H, Brosseron F, Buerger K, CatakC,
Fliessbach K, Franke C, Fuentes M, Heneka MT, Janowitz D, Kilimann I, LaskeC,
Menne F, Nestor P, Peters O, Priller J, Pross V, Ramirez A, Schneider A,Speck O,
Spruth EJ, Teipel S, Vukovich R, Westerteicher C, Wiltfang J,Wolfsgruber S,
Wagner M, Düzel E. Design and first baseline data of the DZNEmulticenter
observational study on predementia Alzheimer’s disease (DELCODE).Alzheimers Res
Ther. 2018, 10:15. doi：10.1186/s13195-017-0314-2.
[18] Xuanyu Li#, XiaoniWang#, Li Su, Xiaochen Hu, Ying Han*. Sino
Longitudinal Study onCognitive Decline (SILCODE): protocol for a Chinese
longitudinal observationalstudy to develop risk prediction models of conversion
to mild cognitiveimpairment in individuals with subjective cognitive decline.
BMJ Open.2019;9:e028188. DOI: 10.1136/bmjopen-2018-02818.
[19] Wolfsgruber S, Kleineidam L,Wagner M, et al. Differential Risk of
Incident Alzheimer's Disease Dementia in Stable Versus Unstable Patterns of
Subjective Cognitive Decline[J]. J Alzheimers Dis,2016,54(3):1135-1146.
DOI:10.3233/JAD-160407
[20] Jessen F,Wolfsgruber S, Wiese B, et al. AD dementia risk in late MCI,
in early MCI, andin subjective memory impairment[J]. Alzheimers
Dement,2014,10(1):76-83. DOI10.1016/j.jalz.2012.09.017
[21] Bondi M W,Edmonds E C, Jak A J, et al. Neuropsychological criteria for
mild cognitiveimpairment improves diagnostic precision, biomarker associations,
andprogression rates[J]. J Alzheimers Dis,2014,42(1):275-289.
DOI:10.3233/JAD-140276
[22] Siest G, Pillot T, Regis-BaillyA, et al. Apolipoprotein E: an
important gene and protein to follow inlaboratory medicine[J]. Clin
Chem,1995,41(8 Pt 1):1068-1086. DOI: 无
[23] Farrer L A,Cupples L A, Haines J L, et al. Effects of age, sex, and
ethnicity on theassociation between apolipoprotein E genotype and Alzheimer
disease. Ameta-analysis. APOE and Alzheimer Disease Meta Analysis Consortium[J].
JAMA,1997,278(16):1349-1356. DOI:10.1001/jama.1997. 03550160069041
[24] Olsson B, Lautner R, AndreassonU, et al. CSF and blood biomarkers for
the diagnosis of Alzheimer's disease: asystematic review and meta-analysis[J].
Lancet Neurol,2016,15(7):673-684.DOI:10.1016/S1474-4422(16)00070-3
[25] 中国医师协会检验医师分会阿尔茨海默病检验医学专家委. 阿尔茨海默病检验诊断报告模式专家共识[J].
中华医学杂志,2016,96(14):1080-1082. DOI: 10.3760/cma.j.issn.0376-2491.2016.14. 003
[26] Folstein M F, Folstein S E,Mchugh P R. "Mini-mental state". A
practical method for grading thecognitive state of patients for the
clinician[J]. J PsychiatrRes,1975,12(3):189-198. DOI:
10.1016/0022-3956(75)90026-6
[27] 王征宇，张明园. 中文版简易智能状态检查(MMSE)的应用[J]. 上海精神医学,1989,1(3):108-111. DOI: 无
[28] Santana I, Duro D, Lemos R, etal. [Mini-Mental State Examination:
Screening and Diagnosis of CognitiveDecline, Using New Normative Data][J]. Acta
Med Port,2016,29(4):240-248.DOI:10.20344/amp.6889
[29] Nasreddine ZS, Phillips N A, Bedirian V, et al. The Montreal Cognitive
Assessment, MoCA: abrief screening tool for mild cognitive impairment[J]. J Am
GeriatrSoc,2005,53(4):695-699. DOI:10.1111/j.1532-5415.2005.53221.x
[30] 王炜，刘丹丹，高中宝，等.
蒙特利尔认知评估量表(中文版)在驻京军队离退休干部中界值划分的初步研究[J].中华保健医学杂志,2010,12(4):271-273.
DOI:10.3969/j.issn.1674-3245.2010.04.011
[31] Chen K L, XuY, Chu A Q, et al. Validation of the Chinese Version of
Montreal CognitiveAssessment Basic for Screening Mild Cognitive Impairment[J]. J
Am GeriatrSoc,2016,64(12):e285-e290. DOI:10.1111/jgs.14530
[32] Guo Q H, Zhou B, Zhao Q H, etal. Memory and Executive Screening (MES):
a brief cognitive test for detectingmild cognitive impairment[J]. BMC
Neurol,2012,12:119. DOI:10.1186/1471-2377-12-119
[33] 郭起浩，洪震. 神经心理评估(第二版)[M]. 上海科学技术出版社,2016.100-104.
[34] Guo Q, Zhao Q, Chen M, et al. Acomparison study of mild cognitive
impairment with 3 memory tests among Chineseindividuals[J]. Alzheimer Dis Assoc
Disord,2009,23(3):253-259. DOI:10.1097/WAD.0b013e3181999e92
[35] Zhao Q, GuoQ, Li F, et al. The Shape Trail Test: application of a new
variant of the Trailmaking test[J]. PLoS One,2013,8(2):e57333.
DOI:10.1371/journal.pone.0057333
[36] 陆骏超，郭起浩，洪震，等. 连线测验(中文修订版)在早期识别阿尔茨海默病中的作用[J].
中国临床心理学杂志,2006,14(2):118-120. DOI:10.3969/j.issn.1005-3611.2006.02.003
[37] E K, H G, S W. Boston NamingTest[M]. Philadelphia Lea &
Febiger,1983.
[38] 史伟雄，郭起浩，洪震，等. 轻度认知功能损害患者的听觉词语记忆特点[J]. 中华老年医学杂志,2006,25(2):93-96.
DOI:10.3321/j.issn:1000-6729.2006.02.003
[39] Hamilton M. A rating scale fordepression[J]. J Neurol Neurosurg
Psychiatry,1960,23:56-62. DOI:无
[40] Hamilton M.The assessment of anxiety states by rating[J]. Br J
MedPsychol,1959,32(1):50-55. DOI: 无
[41] 汪向东，王希林，马弘. 增订版心理卫生评定量表手册[M]. 中国心理卫生杂志社,1999.444-451.
[42] 汪向东，王希林，马弘. 增订版心理卫生评定量表手册[J]. 中国心理卫生杂志社,1999(12):507-512.
[43] Yesavage J A,Brink T L, Rose T L, et al. Development and validation of
a geriatricdepression screening scale: a preliminary report[J]. J
PsychiatrRes,1982,17(1):37-49. DOI: 10.1016/0022- 3956(82)90033-4
[44] 梅锦荣. 老年抑郁量表和普通健康问卷(简本)信度和效度的研究[J].
中华精神科杂志,1999(1):41.DOI:10.3760/j:issn:1006-7884.1999.01.013
[45] Cummings J L.The Neuropsychiatric Inventory: assessing psychopathology
in dementiapatients[J]. Neurology,1997,48(5 Suppl 6):S10-S16.
DOI:10.1212/WNL.48.5_Suppl_6.10S
[46] 解恒革，王鲁宁，于欣，等. 认知功能正常的社区老年人精神行为症状的现况调查[J]. 中国临床康复,2004,8(25):5233-5235.
DOI:10.3321/j.issn:1673-8225.2004.25.028
[47] Cummings J L,Mega M, Gray K, et al. The Neuropsychiatric Inventory:
comprehensive assessmentof psychopathology in dementia[J].
Neurology,1994,44(12):2308-2314. DOI:10.1212/WNL.44.12.2308
[48] Sheikh F, Ismail Z, Mortby M E,et al. Prevalence of mild behavioral
impairment in mild cognitive impairmentand subjective cognitive decline, and its
association with caregiver burden[J].Int Psychogeriatr,2017:1-12.
DOI:10.1017/S104161021700151X
[49] Dauphinot V,Ravier A, Novais T, et al. Risk Factors of Caregiver
Burden Evolution, forPatients With Subjective Cognitive Decline or
Neurocognitive Disorders: ALongitudinal Analysis[J]. J Am Med Dir
Assoc,2016,17(11):1037-1043. DOI:10.1016/j.jamda.2016.07.003
[50] Pfeffer R I, Kurosaki T T,Harrah C J, et al. Measurement of functional
activities in older adults in thecommunity[J]. J Gerontol,1982,37(3):323-329.
DOI: 10.1093/geronj/37.3.323
[51] Buysse D J,Reynolds C R, Monk T H, et al. The Pittsburgh Sleep Quality
Index: a newinstrument for psychiatric practice and research[J].
PsychiatryRes,1989,28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4
[52] 刘贤臣，唐茂芹，胡蕾，等. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志,1996(02):103-107.DOI:
无
[53] Stiasny-Kolster K, Mayer G,Schafer S, et al. The REM sleep behavior
disorder screening questionnaire--anew diagnostic instrument[J]. Mov
Disord,2007,22(16):2386-2393. DOI:10.1002/mds.21740
[54] Nomura T, Inoue Y, Kagimura T,et al. Utility of the REM sleep behavior
disorder screening questionnaire(RBDSQ) in Parkinson's disease patients[J].
Sleep Med,2011,12(7):711-713.DOI:10.1016/j.sleep.2011.01.015
[55] Johns M W. Anew method for measuring daytime sleepiness: the Epworth
sleepiness scale[J].Sleep,1991,14(6):540-545. DOI: 10.1093/sleep/14.6.540
[56] Oldfield R C. The assessmentand analysis of handedness: the Edinburgh
inventory[J].Neuropsychologia,1971,9(1):97-113. DOI:
10.1016/0028-3932(71)90067-4
[57] Edlin J M,Leppanen M L, Fain R J, et al. On the use (and misuse?) of
the EdinburghHandedness Inventory[J]. Brain Cogn,2015,94:44-51.
DOI:10.1016/j.bandc.2015.01.003
[58] Gifford K A, Liu D, Romano R R,et al. Development of a subjective
cognitive decline questionnaire using itemresponse theory: a pilot study[J].
Alzheimers Dement (Amst),2015,1(4):429-439.DOI:10.1016/j.dadm.2015.09.004
[59] Hao L, WangX, Zhang L, et al. Prevalence, Risk Factors, and Complaints
Screening ToolExploration of Subjective Cognitive Decline in a Large Cohort of
the ChinesePopulation[J]. J Alzheimers Dis,2017,60(2):371-388.
DOI:10.3233/JAD-170347
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