Tracking Early Decline in Cognitive Function in Older Individuals at Risk for Alzheimer Disease Dementia The Alzheimer's Disease Cooperative Study Cognitive Function Instrument
Tracking Early Decline in Cognitive Function in Older Individuals at Risk for Alzheimer Disease Dementia The Alzheimer's Disease Cooperative Study Cognitive Function Instrument
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追踪阿尔茨海默病痴呆症高危老年人认知功能的早期衰退 阿尔茨海默病合作研究认知功能工具
DOI：
10.1001/jamaneurol.2014.3375
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发表时间：
2015-04-01
期刊：
影响因子：
29
通讯作者：
Sperling, Reisa A.
中科院分区：
文献类型：
--
作者：
Amariglio, Rebecca E.;Donohue, Michael C.;Sperling, Reisa A.
几项大规模的阿尔茨海默病（AD）二级预防试验已经开始针对临床前阶段的个体。这些试验的成功取决于有效的结果措施，这些措施对最初无症状的个体的早期临床进展敏感。目的研究认知功能仪器（CFI）在基线时无临床损害的老年个体中跟踪认知功能早期变化的效用。和参与者纵向研究从2002年2月到2007年2月在参与阿尔茨海默病合作研究网站。在基线访视后，每年对个体进行48个月的随访。该研究纳入了468名健康老年人（临床痴呆评定量表[CDR]总体评分为0，高于改良简易精神状态检查和自由提示选择性提醒测试的临界值）（平均[SD]年龄，79.4 [3.6]岁;年龄范围，75.0-93.8岁）。所有研究参与者及其研究伴侣每年完成一次自我和伴侣CFI。个体同时进行年度神经心理学评估和APOE基因分型。主要结果和测量临床进展者（CDR评分，>= 0.5）和非进展者（CDR评分，0）之间以及APOE β 4携带者和非携带者之间的CFI评分进行了比较。纵向评估CFI评分和神经心理学表现之间变化的相关性。结果在48个月时，临床进展者和非进展者之间的自我（2.13，SE=0.45，P <0.001），伴侣（5.08，SE=0.59，P <0.001）和自我加伴侣（7.04，SE=0.83，P <0.001）CFI总分的组间差异显著。在48个月时，APOE β 4携带者在伴侣（1.10，SE=0.44，P <0.012）和自身+伴侣（1.56，SE=0.63，P <0.014）CFI评分上的进展比非携带者更大。自我和伴侣的CFI变化都与纵向认知下降相关（自身，rho=0.32，95% CI，0.13 ~ 0.46;伴侣，rho=0.56，95%CI，0.42至0.68），尽管研究结果表明自我报告在过程的早期可能更准确，而当进展到认知障碍时，伴侣报告的准确性提高。长期的临床获益对于最近启动的二级预防试验的成功至关重要。CFI似乎是一个简短的，但信息丰富的潜在结果的措施，提供洞察功能的能力，在疾病的最早阶段。
IMPORTANCE Several large-scale Alzheimer disease (AD) secondary prevention trials have begun to target individuals at the preclinical stage. The success of these trials depends on validated outcome measures that are sensitive to early clinical progression in individuals who are initially asymptomatic.OBJECTIVE To investigate the utility of the Cognitive Function Instrument (CFI) to track early changes in cognitive function in older individuals without clinical impairment at baseline.DESIGN, SETTING, AND PARTICIPANTS Longitudinal study from February 2002 through February 2007 at participating Alzheimer's Disease Cooperative Study sites. Individuals were followed up annually for 48 months after the baseline visit. The study included 468 healthy older individuals (Clinical Dementia Rating scale [CDR] global scores of 0, above cutoff on the modified Mini-Mental State Examination and Free and Cued Selective Reminding Test) (mean [SD] age, 79.4 [3.6] years; age range, 75.0-93.8 years). All study participants and their study partners completed the self and partner CFIs annually. Individuals also underwent concurrent annual neuropsychological assessment and APOE genotyping.MAIN OUTCOMES AND MEASURES The CFI scores between clinical progressors (CDR score, >= 0.5) and nonprogressors (CDR score, 0) and between APOE epsilon 4 carriers and noncarriers were compared. Correlations of change between the CFI scores and neuropsychological performance were assessed longitudinally. RESULTS At 48 months, group differences between clinical progressors and non-progressors were significant for self (2.13, SE=0.45, P < .001), partner (5.08, SE=0.59, P < .001), and self plus partner (7.04, SE=0.83, P < .001) CFI total scores. At month 48, APOE epsilon 4 carriers had greater progression than noncarriers on the partner (1.10, SE=0.44, P < .012) and self plus partner (1.56, SE=0.63, P < .014) CFI scores. Both self and partner CFI change were associated with longitudinal cognitive decline (self, rho=0.32, 95% CI, 0.13 to 0.46; partner, rho=0.56, 95% CI, 0.42 to 0.68), although findings suggest self-reportmay be more accurate early in the process, whereas accuracy of partner report improves when there is progression to cognitive impairment.CONCLUSIONS AND RELEVANCE Demonstrating long-term clinical benefit will be critical for the success of recently launched secondary prevention trials. The CFI appears to be a brief, but informative potential outcome measure that provides insight into functional abilities at the earliest stages of disease.