The influence of chronic stress on dementia-related diagnostic change in older adults.
The influence of chronic stress on dementia-related diagnostic change in older adults.
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DOI：
10.1097/wad.0b013e3182389a9c
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发表时间：
2012-07
影响因子：
2.1
通讯作者：
Galasko D
中科院分区：
文献类型：
--
作者：
Peavy GM;Jacobson MW;Salmon DP;Gamst AC;Patterson TL;Goldman S;Mills PJ;Khandrika S;Galasko D
老化的大脑对慢性应激和与早期痴呆相关的神经病理的敏感性增加，可能会加速认知能力的下降。我们调查了参与阿尔茨海默病研究中心纵向研究的62名个体(平均年龄=78.7岁)慢性应激与诊断改变之间的关系。在基线时被诊断为认知正常(CN)或轻度认知障碍(MCI)的受试者平均随访2.5年。资深神经科医生对压力和认知的详细测量视而不见，每年都会做出诊断。Logistic回归分析评估了压力测量(基于事件的评级、皮质醇水平)预测转化为MCI和痴呆症的准确性。11名MCI患者在随访期间被诊断为痴呆症。16个从CN转换为MCI。长期的、高度紧张的经历与从MCI转变为痴呆症有关。皮质醇唤醒反应与年龄和教育程度有关，与MCI的诊断变化有关。皮质醇测定与从MCI到痴呆症的进展无关，压力经历和MCI的变化之间也没有关联。从正常认知向MCI转变的相关机制可能与诊断转变为痴呆症的机制不同。这些发现有助于确定干预策略，以降低不同易感阶段的下降风险。
Increased susceptibility of the aging brain to both chronic stress and incipient dementia-related neuropathology may accelerate cognitive decline. We investigated associations between chronic stress and diagnostic change in 62 individuals (mean age=78.7) participating in an Alzheimer’s disease research center longitudinal study. Subjects, diagnosed at baseline as cognitively normal (CN) or Mild Cognitive Impairment (MCI) were followed an average of 2.5 years. Senior neurologists, blind to detailed measures of stress and cognition, assigned diagnoses annually. Logistic regression analyses assessed accuracy with which measures of stress (event-based ratings, cortisol levels) predicted conversion to MCI and dementia. Eleven individuals with MCI at baseline received a dementia diagnosis during follow-up. Sixteen converted from CN to MCI. Prolonged, highly stressful experiences were associated with conversion from MCI to dementia. The cortisol awakening response, with age and education, was associated with diagnostic change to MCI. Cortisol measures were not associated with progression from MCI to dementia, and there was no association between stressful experiences and change to MCI. Mechanisms associated with the transition from normal cognition to MCI may differ from those associated with diagnostic change to dementia. These findings could facilitate identification of interventional strategies to reduce risk of decline at different stages of susceptibility.