Describing the Sequence of Cognitive Decline in Alzheimer's Disease Patients: Results from an Observational Study.
Describing the Sequence of Cognitive Decline in Alzheimer's Disease Patients: Results from an Observational Study.
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DOI：
10.3233/jad-150852
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Lebrec J
中科院分区：
文献类型：
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作者：
Henneges C;Reed C;Chen YF;Dell'Agnello G;Lebrec J
背景：加深对阿尔茨海默病 (AD) 认知能力下降模式的了解将有助于帮助初级保健医生向患者和护理人员解释 AD 的进展情况。目的：确定社区 AD 患者认知能力下降的顺序。方法：对参加为期 18 个月的观察性 GERAS 研究的 1,495 名诊断为疑似 AD 且简易精神状态检查 (MMSE) 评分≤ 26 的患者进行基线数据分析。应用比例优势逻辑回归模型对MMSE子评分（定向、注册、注意和集中、回忆、语言和绘画）以及阿尔茨海默病评估量表（ADAS-cog）认知子量表的相应子评分进行建模，使用MMSE总分作为疾病进展的指标。在每个 MMSE 总分水平上估计损伤开始和完全损伤的概率。结果：从作为 MMSE 总分函数的每个 MMSE 子分数的估计概率来看，认知开始受损的第一个方面是回忆，其次是时间定向、注意力和集中度、地点定向、语言、绘画和注册。对于单项分数的全面损害，顺序是回忆、绘画、注意和集中、时间定向、地点定向、注册和语言。相应 ADAS-cog 子分数的认知能力下降顺序与这种模式非常一致。结论：AD 认知能力下降的顺序可以使用认知关键方面的概率估计在动画中可视化。这可能有助于临床医生为患者和护理人员设定疾病进展的期望。
Background: Improved understanding of the pattern of cognitive decline in Alzheimer’s disease (AD) would be useful to assist primary care physicians in explaining AD progression to patients and caregivers. Objective: To identify the sequence in which cognitive abilities decline in community-dwelling patients with AD. Methods: Baseline data were analyzed from 1,495 patients diagnosed with probable AD and a Mini-Mental State Examination (MMSE) score ≤ 26 enrolled in the 18-month observational GERAS study. Proportional odds logistic regression models were applied to model MMSE subscores (orientation, registration, attention and concentration, recall, language, and drawing) and the corresponding subscores of the cognitive subscale of the Alzheimer’s Disease Assessment Scale (ADAS-cog), using MMSE total score as the index of disease progression. Probabilities of impairment start and full impairment were estimated at each MMSE total score level. Results: From the estimated probabilities for each MMSE subscore as a function of the MMSE total score, the first aspect of cognition to start being impaired was recall, followed by orientation in time, attention and concentration, orientation in place, language, drawing, and registration. For full impairment in subscores, the sequence was recall, drawing, attention and concentration, orientation in time, orientation in place, registration, and language. The sequence of cognitive decline for the corresponding ADAS-cog subscores was remarkably consistent with this pattern. Conclusion: The sequence of cognitive decline in AD can be visualized in an animation using probability estimates for key aspects of cognition. This might be useful for clinicians to set expectations on disease progression for patients and caregivers.