Mild cognitive impairment represents early-stage Alzheimer disease
Mild cognitive impairment represents early-stage Alzheimer disease
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DOI：
10.1001/archneur.58.3.397
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发表时间：
2001-03-01
影响因子：
--
通讯作者：
Berg, L
中科院分区：
文献类型：
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作者：
Morris, JC;Storandt, M;Berg, L
背景资料：轻度认知功能障碍（MCI）被认为是一个过渡阶段之间的老化和阿尔茨海默病（AD）。目的：以确定是否MCI代表早期AD通过检查其自然史和神经病理学basis.Design：一个前瞻性的临床和心理研究的社区生活的老年志愿者，无论是非痴呆症和最低限度的认知功能障碍，随访长达9.5年。神经病理学检查进行了参与者谁经历了incorporation.Setting：AD research center.Participants：所有参与者在1990年7月和1997年6月之间登记的临床痴呆评分（CDR）评分为0（认知健康; n=177;平均年龄，78.9岁）或0.5（相当于MCI; n=277;平均年龄，76.9岁）。根据MCI代表阿尔茨海默型痴呆（DAT）的临床置信度，确定了CDR评分为0.5的3个亚组：CDR 0.5/DAT、CDR 0.5/初期DAT和CDR 0.5/不确定性痴呆。主要结果测量：进展至CDR 1阶段，其特征为轻度明确的DAT。生存分析显示，100%的CDR 0.5/ DAT参与者在9.5年的时间内进展到更严重的痴呆症。5年时，进展至CDR 1分的比率DAT（或更高）为60.5%（95%置信区间[CI]，50.2%-70.8%），CDR 0.5/DAT组，35.7% CDR 0.5/初始DAT组为19.9%（95%CI，8.0%-31.8%），CDR 0.5/不确定痴呆组为19.9%（95%CI，21.0%-50.3%），CDR 0/对照组为6.8%（95%CI，2.2%-11.3%）。进展至更严重的痴呆程度与基线时的认知障碍程度相关。24的25名参与者与CDR 0.5的分数有神经病理性痴呆症，这是AD在21（84%）。结论：个人目前的特点是MCI进展稳定到更大阶段的痴呆症的严重程度，在入口处的认知功能障碍的水平，他们几乎总是有AD的神经病理学特征。我们的结论是MCI通常代表早期AD。
Background: Mild cognitive impairment (MCI) is considered to be a transitional stage between aging and Alzheimer disease (AD).Objective: To determine whether MCI represents early-stage AD by examining its natural history and neuropathologic basis.Design: A prospective clinical and psychometric study of community-living elderly volunteers, both nondemented and minimally cognitively impaired, followed up for up to 9.5 years. Neuropathologic examinations were performed on participants who had undergone autopsy.Setting: An AD research center.Participants: All participants enrolled between July 1990 and June 1997 with Clinical Dementia Rating (CDR) scores of 0 (cognitively healthy; n=177; mean age, 78.9 years) or 0.5 (equivalent to MCI; n=277; mean age, 76.9 years). Based on the degree of clinical confidence that MCI represented dementia of the Alzheimer type (DAT), 3 subgroups of individuals with CDR scores of 0.5 were identified: CDR 0.5/DAT, CDR 0.5/incipient DAT, and CDR 0.5/uncertain dementia.Main Outcome Measure: Progression to the stage of CDR 1, which characterizes mild definite DAT.Results: Survival analysis showed that 100% of CDR 0.5/ DAT participants progressed to greater dementia severity over a 9.5-year period. At 5 years, rates of progression to a score of CDR 1 (or greater) for DAT were 60.5% (95% confidence interval [CI], 50.2%-70.8%) for the CDR 0.5/DAT group, 35.7% (95% CI, 21.0%-50.3%) for the CDR 0.5/incipient DAT group, 19.9% (95% CI, 8.0%31.8%) for the CDR 0.5/uncertain dementia group, and 6.8% (95% CI, 2.2%-11.3%) for CDR 0/controls. Progression to greater dementia severity correlated with degree of cognitive impairment at baseline. Twenty-four of the 25 participants with scores of CDR 0.5 had a neuropathologic dementing disorder, which was AD in 21 (84%).Conclusions: Individuals currently characterized as having MCI progress steadily to greater stages of dementia severity at rates dependent on the level of cognitive impairment at entry and they almost always have the neuropathologic features of AD. We conclude that MCI generally represents early-stage AD.