Subjective cognitive complaints contribute to misdiagnosis of mild cognitive impairment.
Subjective cognitive complaints contribute to misdiagnosis of mild cognitive impairment.
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DOI：
10.1017/s135561771400068x
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发表时间：
2014-09
期刊：
影响因子：
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通讯作者：
Alzheimer’s Disease Neuroimaging Initiative
中科院分区：
文献类型：
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作者：
Edmonds EC;Delano-Wood L;Galasko DR;Salmon DP;Bondi MW;Alzheimer’s Disease Neuroimaging Initiative
主观认知障碍是轻度认知障碍 (MCI) 的诊断标准，尽管它们与 MCI 客观记忆表现的关系不确定。我们的目的是检查阿尔茨海默病神经影像倡议 (ADNI) MCI 队列亚组中自我报告的认知问题，以确定它们是否对 MCI 诊断有价值，或者是否会导致误诊。 MCI 亚组是通过对 448 名 ADNI MCI 参与者的基线神经心理学测试数据进行聚类分析得出的。通过日常认知（ECog）问卷评估认知投诉，并计算自我报告和知情者报告之间的差异分数。聚类分析揭示了遗忘和混合认知表型以及第三个聚类衍生的正常亚组（41.3%），其神经心理学和脑脊液（CSF）阿尔茨海默病（AD）生物标志物谱与“稳健”正常对照组没有差异。 MCI 参与者的这种认知完整表型高估了他们相对于知情者的认知问题，而具有客观记忆障碍的遗忘 MCI 参与者则低估了他们的认知问题。认知问题的低估与脑脊液 AD 生物标志物阳性和痴呆进展相关。总体而言，自我报告的认知抱怨与客观认知功能之间没有关系，但观察到与抑郁症状存在显着相关性。将自我报告的主诉纳入 MCI 诊断标准可能会掩盖而不是澄清诊断，并导致 MCI 误分类率很高。自我报告和知情者报告之间的差异表明，高估认知问题是正常衰老的特征，而低估可能反映出认知能力下降的更大风险。
Subjective cognitive complaints are a criterion for the diagnosis of mild cognitive impairment (MCI), despite their uncertain relationship to objective memory performance in MCI. We aimed to examine self-reported cognitive complaints in subgroups of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) MCI cohort to determine whether they are a valuable inclusion in the diagnosis of MCI or, alternatively, if they contribute to misdiagnosis. Subgroups of MCI were derived using cluster analysis of baseline neuropsychological test data from 448 ADNI MCI participants. Cognitive complaints were assessed via the Everyday Cognition (ECog) questionnaire, and discrepancy scores were calculated between self- and informant-report. Cluster analysis revealed Amnestic and Mixed cognitive phenotypes as well as a third Cluster-Derived Normal subgroup (41.3%), whose neuropsychological and cerebrospinal fluid (CSF) Alzheimer’s disease (AD) biomarker profiles did not differ from a “robust” normal control group. This cognitively intact phenotype of MCI participants overestimated their cognitive problems relative to their informant, whereas Amnestic MCI participants with objective memory impairment underestimated their cognitive problems. Underestimation of cognitive problems was associated with positive CSF AD biomarkers and progression to dementia. Overall, there was no relationship between self-reported cognitive complaints and objective cognitive functioning, but significant correlations were observed with depressive symptoms. The inclusion of self-reported complaints in MCI diagnostic criteria may cloud rather than clarify diagnosis and result in high rates of misclassification of MCI. Discrepancies between self- and informant-report demonstrate that overestimation of cognitive problems is characteristic of normal aging while underestimation may reflect greater risk for cognitive decline.