Measurement of Dimensions of Self-awareness of Memory Function and Their Association With Clinical Progression in Cognitively Normal Older Adults.
Measurement of Dimensions of Self-awareness of Memory Function and Their Association With Clinical Progression in Cognitively Normal Older Adults.
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DOI：
10.1001/jamanetworkopen.2023.9964
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发表时间：
2023-04-03
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
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作者：
单独的、基于项目的记忆功能意识缺失或意识增强的测量与临床前阿尔茨海默病到症状性阿尔茨海默病的未来进展有关吗？在这项对436名老年人进行的队列研究中，较差的无意识得分与临床进展的风险显著增加相关，而在提高意识或传统意识措施方面没有发现显著结果。在这项研究中，无意识，而不是意识的增强，与未来的临床进展密切相关；分离这一维度可以在阿尔茨海默病的认知调查中提供更高的灵敏度和特异性。这项队列研究调查了一种新的记忆功能自我意识测量与阿尔茨海默病未来临床进展的关系，这些个体在基线时认知正常。在认知正常的老年人中，分别探索记忆功能自我意识的两个维度——意识增强和意识减弱的能力，为了解与阿尔茨海默病风险相关的两个方向的细微变化提供了重要的机会。在基线认知正常的个体中，研究一种新的记忆功能自我意识测量与未来临床进展的关系。这项队列研究使用了来自阿尔茨海默病神经影像学倡议的数据，这是一项多中心研究。参与者是基线认知正常（即临床痴呆评分[CDR]总体评分为0）的老年人，随访至少2年。数据收集于2010年6月至2021年12月，并于2022年1月18日从南加州大学神经成像实验室数据库中提取。临床进展定义为连续2次随访CDR量表总体得分达到0.5或更高的第一例。传统的意识得分是通过计算参与者和他们的研究伙伴在日常认知问卷上的得分之间的平均差异来衡量的。在平均之前，通过将项目水平的正或负差异封顶为零来生成无意识或增强意识的子得分。主要结局——未来临床进展的风险——使用Cox回归分析对每个基线认知测量进行分析。另外，使用线性混合效应模型比较了每个测量的纵向轨迹。436人的样本中包括232名（53.2%）女性参与者，平均（SD）年龄为74.5（6.7）岁；黑人25人（5.7%），西班牙裔14人（3.2%），白人398人（91.3%）；91名参与者（20.9%）在观察期间出现临床进展。生存分析显示，无意识亚评分每提高1分，进展风险降低84%(风险比，0.16 [95% CI, 0.07-0.35]; P <。001)，或者等价地，1分的降低与进展危险增加540%相关（95% CI， 183%至1347%），对于提高意识或传统评分没有显著结果。在这项对436名认知正常的老年人进行的队列研究中，对记忆衰退的不意识而不是高度意识与未来的临床进展密切相关，这进一步支持了不一致的自我和线人报告的认知衰退可能为从业者提供重要信息。
Are separate, item-based measures of unawareness or heightened awareness of memory function associated with future progression from preclinical to symptomatic Alzheimer disease? In this cohort study of 436 older adults, worse unawareness scores were associated with a significantly higher hazard of clinical progression, with no significant results found for the heightened awareness or traditional awareness measures. In this study, unawareness, rather than heightened awareness, was strongly associated with future clinical progression; isolating this dimension could provide greater sensitivity and specificity in investigation of awareness in Alzheimer disease. This cohort study investigates the association of a novel measure for self-awareness of memory function with future clinical progression toward Alzheimer disease in individuals who were cognitively normal at baseline. The ability to separately explore 2 dimensions of self-awareness of memory function—increased and decreased awareness—in cognitively normal older adults provides an important opportunity to understand subtle changes in either direction in relation to risk of Alzheimer disease. To investigate the association of a novel measure for self-awareness of memory function with future clinical progression in individuals who were cognitively normal at baseline. This cohort study used data from the Alzheimer’s Disease Neuroimaging Initiative, a multicenter study. Participants were older adults who were cognitively normal (ie, Clinical Dementia Rating [CDR] global score of 0) at baseline and had at least 2 years of follow-up. Data were collected from June 2010 to December 2021 and pulled from the University of Southern California Laboratory of Neuro Imaging database on January 18, 2022. Clinical progression was defined as the first instance of 2 consecutive follow-up CDR scale global scores of 0.5 or greater. A traditional awareness score was measured by calculating the mean discrepancy between the participant and their study partner’s scores on the Everyday Cognition questionnaire. An unawareness or heightened awareness subscore was generated by capping item-level positive or negative differences at zero before averaging. The main outcome—risk of future clinical progression—was analyzed for each baseline awareness measure using Cox regression analysis. Longitudinal trajectories of each measure were additionally compared using linear mixed-effects models. The 436-person sample included 232 (53.2%) female participants, with a mean (SD) age of 74.5 (6.7) years; 25 participants (5.7%) were Black, 14 (3.2%) Hispanic, and 398 (91.3%) White; and 91 participants (20.9%) clinically progressed over their period of observation. Survival analyses showed that a 1-point improvement on the unawareness subscore was associated with an 84% reduction in progression hazard (hazard ratio, 0.16 [95% CI, 0.07-0.35]; P < .001), or equivalently, a 1-point decrease was associated with a 540% increase in progression hazard (95% CI, 183% to 1347%), with no significant results for the heightened awareness or traditional scores. In this cohort study of 436 cognitively normal older adults, unawareness, rather than heightened awareness, of memory decline was strongly associated with future clinical progression, providing further support that discordant self- and informant-reported cognitive decline may provide important information to practitioners.
主观认知下降的定量线人和自我报告预测了独立于年龄和APOEε4的认知无损害个体中淀粉样蛋白βPET的结果。
DOI：
10.1002/dad2.12127
发表时间：
2020
期刊：
Alzheimer's & dementia (Amsterdam, Netherlands)
影响因子：
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作者：
Sánchez-Benavides G;Salvadó G;Arenaza-Urquijo EM;Grau-Rivera O;Suárez-Calvet M;Milà-Alomà M;González-de-Echávarri JM;Minguillon C;Crous-Bou M;Niñerola-Baizán A;Perissinotti A;Gispert JD;Molinuevo JL;ALFA Study
通讯作者：
ALFA Study