Word-List Intrusion Errors Predict Progression to Mild Cognitive Impairment
Word-List Intrusion Errors Predict Progression to Mild Cognitive Impairment
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DOI：
10.1037/neu0000413
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发表时间：
2018-02-01
期刊：
影响因子：
2.4
通讯作者：
Bondi, Mark W.
中科院分区：
文献类型：
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作者：
Thomas, Kelsey R.;Eppig, Joel;Bondi, Mark W.
目的：临床前阿尔茨海默病（AD）在认知正常的情况下由阳性AD生物标志物定义，被认为先于轻度认知障碍（MCI）。临床前AD患者的细微认知缺陷和认知效率低下可以通过神经心理学测试的过程和错误评分来检测。方法：对来自阿尔茨海默病神经影像学倡议的认知正常参与者（n = 525）进行长达5年的随访，并将其分为稳定正常（n = 305）或进展为轻度认知障碍（n = 220）。使用Cox回归来确定Rey听觉言语学习测试（AVLT）的基线过程得分；在考虑了人口统计学特征、载脂蛋白E epsilon 4状态、脑脊液AD生物标志物、缺血风险、情绪、功能困难和标准神经心理学总分后，入侵错误、学习斜率、主动干扰、回顾性干扰)预测MCI的进展和临床痴呆评分（CDR）为1分。结果：基线AVLT入侵错误预测MCI进展（风险比= 1.04,95%置信区间1.01-1.07,p = 0.008），在模型中已有其他有价值的预测因子后，模型拟合得到改善，chi(2)(df = 1) = 6.330, p = 0.012。AVLT入侵错误也预测进展到CDR = 1（风险比= 1.10,95%置信区间1.02-1.18,p = 0.016），再次改进模型拟合，chi(2)(df = 1) = 4.682, p = 0.030。结论：AVLT的入侵误差对预测从正常认知到轻度认知损伤和正常认知到轻度痴呆（CDR = 1）的进展具有独特的价值。侵入性错误似乎反映了神经心理学总分检测到的认知损伤之前的细微变化和效率低下。
Objective: Preclinical Alzheimer's disease (AD) defined by a positive AD biomarker in the presence of normal cognition is presumed to precede mild cognitive impairment (MCI). Subtle cognitive deficits and cognitive inefficiencies in preclinical AD may be detected through process and error scores on neuropsychological tests in those at risk for progression to MCI. Method: Cognitively normal participants (n = 525) from the Alzheimer's Disease Neuroimaging Initiative were followed for up to 5 years and classified as either stable normal (n = 305) or progressed to MCI (n = 220). Cox regressions were used to determine whether baseline process scores on the Rey Auditory Verbal Learning Test (AVLT; intrusion errors, learning slope, proactive interference, retroactive interference) predicted progression to MCI and a Clinical Dementia Rating (CDR) score of 1 after considering demographic characteristics, apolipoprotein E epsilon 4 status, cerebrospinal fluid AD biomarkers, ischemia risk, mood, functional difficulty, and standard neuropsychological total test scores for the model. Results: Baseline AVLT intrusion errors predicted progression to MCI (hazard ratio = 1.04, 95% confidence interval 1.01-1.07, p = .008) and improved model fit after the other valuable predictors were already in the model, chi(2)(df = 1) = 6.330, p =.012. AVLT intrusion errors also predicted progression to CDR = 1 (hazard ratio = 1.10, 95% confidence interval 1.02-1.18, p =.016) and again improved model fit, chi(2)(df = 1) = 4.682, p =.030. Conclusions: Intrusion errors on the AVLT contribute unique value for predicting progression from normal cognition to MCI and normal cognition to mild dementia (CDR = 1). Intrusion errors appear to reflect subtle change and inefficiencies in cognition that precede impairment detected by neuropsychological total scores.