Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment
Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment
复制标题
DOI：
10.1001/archpsyc.64.12.1443
复制
发表时间：
2007-12-01
影响因子：
--
通讯作者：
Blacker, Deborah
中科院分区：
文献类型：
--
作者：
Dickerson, Bradford C.;Sperling, Reisa A.;Blacker, Deborah
目的：确定对轻度认知障碍 (MCI) 范围内的损伤严重程度进行分级的临床评估方法是否可以预测临床病程，特别是在临床试验中不符合正式 MCI 标准的轻度损伤个体中。设计：队列。设置：社区志愿者。参与者：来自正常人的纵向研究（临床痴呆评级 [CDR]= 0； n=77) 和轻度受损 (CDR=0.5; n=167) 参与者每年进行 5 次或以上临床评估，使用 CDR 盒总和 (CDR-SB) 对日常生活中的认知障碍基线水平进行分级，并使用神经心理学测试分数对认知表现障碍水平进行分级。 主要结果测量：五年结果测量包括 (1) 可能的阿尔茨海默病 (AD) 诊断 (2) 临床“下降”（CDR-SB 增加 >= 1.0）。 Logistic 回归模型用于评估基线测量预测整个样本结果的能力，以及单独预测不符合多中心临床试验中实施的正式 MCI 标准的受试者的结果的能力（n = 125；“非常轻度认知障碍”[vMCI]）。结果：基线时较高的 CDR-SB 和较低的言语记忆和执行功能预示着 AD 和衰退的可能性更大。五年可能的 AD 率和 vMCI 下降率（20%，AD；49%，下降）介于正常参与者（0%，AD；28%，下降）和 MCI 参与者（41%，AD；62%，下降）之间。在 vMCI 中，可能的 AD 可能性是通过较高的 CDR-SB 和较低的执行功能来预测的。结论：即使对于不符合临床试验中实施的严格 MCI 标准的非常轻度受损的个体，日常生活中的认知障碍程度和神经心理学测试的表现也可以预测 5 年内诊断为 AD 的可能性。临床确定 MCI 范围内损伤的相对严重程度对于推定疾病缓解化合物的试验可能很有价值，特别是当目标人群扩大到包括损伤较轻的个体时。
Objective: To determine whether clinical assessment methods that grade the severity of impairments within the spectrum of mild cognitive impairment (MCI) can predict clinical course, particularly among very mildly impaired individuals who do not meet formal MCI criteria as implemented in clinical trials.Design: Cohort.Setting: Community volunteers.Participants: From a longitudinal study of normal (Clinical Dementia Rating [CDR]= 0; n=77) and mildly impaired (CDR=0.5; n=167) participants with 5 or more annual clinical assessments, baseline level of cognitive impairment in daily life was graded using CDR sum of boxes (CDR-SB) and level of cognitive performance impairment was graded using neuropsychological test scores.Main Outcome Measures: Five-year outcome measures included (1) probable Alzheimer disease (AD) diagnosis and (2) clinical '' decline '' (CDR-SB increase >= 1.0). Logistic regression models were used to assess the ability of baseline measures to predict outcomes in the full sample and separately in the subjects who did not meet formal MCI criteria as implemented in a multicenter clinical trial (n= 125; '' very mild cognitive impairment '' [vMCI]).Results: The presence of both higher CDR-SB and lower verbal memory and executive function at baseline predicted greater likelihood of probable AD and decline. Five-year rates of probable AD and decline in vMCI (20%, AD; 49%, decline) were intermediate between normal participants (0%, AD; 28%, decline) and participants with MCI (41%, AD; 62%, decline). Within vMCI, likelihood of probable AD was predicted by higher CDR-SB and lower executive function.Conclusions: Even in very mildly impaired individuals who do not meet strict MCI criteria as implemented in clinical trials, the degree of cognitive impairment in daily life and performance on neuropsychological testing predict likelihood of an AD diagnosis within 5 years. The clinical determination of relative severity of impairment along the spectrum of MCI may be valuable for trials of putative disease-modifying compounds, particularly as target populations are broadened to include less impaired individuals.