Mild Behavioral Impairment and Subjective Cognitive Decline Predict Cognitive and Functional Decline.
Mild Behavioral Impairment and Subjective Cognitive Decline Predict Cognitive and Functional Decline.
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DOI：
10.3233/jad-201184
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Smith EE
中科院分区：
文献类型：
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作者：
Ismail Z;McGirr A;Gill S;Hu S;Forkert ND;Smith EE
轻度行为障碍(MBI)和主观认知功能下降(SCD)是痴呆的危险状态，可能分别代表早期神经变性的神经行为和神经认知表现。MBI和SCD都可以预测认知功能下降和痴呆症的发生，与已知的痴呆症生物标志物相关，并且都出现在NIA-AA关于AD第二阶段(临床前疾病)的研究框架中。评估MBI和SCD单独和联合与老年人群体中认知和功能衰退事件的相关性。我们检验了MBI和SCD会增加下降风险的假设。认知正常的参与者每年都会在阿尔茨海默病中心接受跟踪调查。Logistic回归分析基线分型(MBI-SCD-、MBI-SCD+、MBI+SCD-或MBI+SCD+)与3年预后的关系。在2,769名参与者(平均年龄=76岁)中，1,536人为MBI-SCD-，254人为MBI-SCD+，743人为MBI+SCD-，236人为MBI+SCD+。3年后，349人(12.6%)降至CDR>；0，其中MBI+组23.1%，SCD+组23.5%，MBI+组和SCD+组交集组30.9%。与SCD-MBI-相比，我们观察到风险依次递增(OR[95%CI])：MBI-SCD+3.61[2.42-5.38](进展16.5%)，MBI+SCD-4.76[3.57-6.34](20.7%)，MBI+SCD+8.15[5.71-11.64](30.9%)。MBI和SCD一起与最大的下降风险相关。这些互补的痴呆症风险综合征可以作为简单和可扩展的方法来识别高危患者进行体检或临床试验充实。
Mild behavioral impairment (MBI) and subjective cognitive decline (SCD) are dementia risk states, and potentially represent neurobehavioral and neurocognitive manifestations, respectively, of early stage neurodegeneration. Both MBI and SCD predict incident cognitive decline and dementia, are associated with known dementia biomarkers, and are both represented in the NIA-AA research framework for AD in Stage 2 (preclinical disease). To assess the associations of MBI and SCD, alone and in combination, with incident cognitive and functional decline in a population of older adults. We tested the hypothesis that MBI and SCD confer additive risk for decline. Cognitively normal participants were followed up annually at Alzheimer’s Disease Centers. Logistic regression assessed the relationship between baseline classification (MBI-SCD-, MBI-SCD+, MBI+SCD-, or MBI+SCD+) and 3-year outcome. Of 2,769 participants (mean age=76), 1,536 were MBI-SCD-, 254 MBI-SCD+, 743 MBI+SCD-, and 236 MBI+SCD+. At 3 years, 349 (12.6%) declined to CDR >0, including 23.1% of the MBI+group, 23.5% of the SCD+group, and 30.9% of the intersection group of both MBI+and SCD+participants. Compared to SCD-MBI-, we observed an ordinal progression in risk (ORs [95% CI]): 3.61 [2.42–5.38] for MBI-SCD+ (16.5% progression), 4.76 [3.57–6.34] for MBI+SCD- (20.7%), and 8.15 [5.71–11.64] for MBI+SCD+(30.9%). MBI and SCD together were associated with the greatest risk of decline. These complementary dementia risk syndromes can be used as simple and scalable methods to identify high-risk patients for workup or for clinical trial enrichment.