Mild Cognitive Impairment: Prodromal Alzheimer's Disease or Something Else?
Mild Cognitive Impairment: Prodromal Alzheimer's Disease or Something Else?
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DOI：
10.3233/jad-2011-110740
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发表时间：
2011-01-01
影响因子：
4
通讯作者：
Kirsch, Wolff M.
中科院分区：
文献类型：
--
作者：
Britt, William G., III;Hansen, Anne M.;Kirsch, Wolff M.
大多数轻度认知障碍（MCI）研究使用基线和一次随访测量来确定该疾病的临床病程。这份MCI临床病程的报告是基于对老年人正常和MCI队列60个月期间的多项神经认知测试的统计评估。这些数据包括一系列基于线人的测量（临床痴呆评分[CDR]）和通过两种不同的回归方法分析的综合神经心理学测试。29名老年参与者进入研究时神经认知正常；26人保持正常，2人发展为轻度认知损伤，1人发展为痴呆。83名参与者作为多域MCI病例进入研究；10人恢复正常，46人保持轻度认知障碍，27人发展为痴呆。27例痴呆患者中有3例在完全尸检后死亡（1例为进行性核上性麻痹，2例确诊为阿尔茨海默病伴严重脑淀粉样血管病（CAA））。如果没有连续测量，尽管恢复正常，但八分之一的MCI可能被错误地归类为“稳定型MCI”。稳定MCI组没有从练习效应中获益，而正常组则有。应用分类和回归树（CART）分析可以从基线值预测参与者的终点状态，准确率为78.6%。多域MCI病例的波动认知状态意味着一个缓解的病理过程，其恢复要素与进行性微血管病变（如CAA）一致。
The majority of mild cognitive impairment (MCI) studies use baseline and one follow-up measurement to determine the clinical course of the disorder. This report of MCI clinical course is based on the a statistical evaluation of multiple neurocognitive tests over a 60 month period in elderly normal and MCI cohorts. The data includes serial informant-based measures (Clinical Dementia Rating [CDR]) and a comprehensive battery of neuropsychological tests analyzed by two different regression methods. Twenty-nine elderly participants entered the study as neurocognitively normal; 26 remained normal, 2 progressed to MCI, and 1 progressed to dementia. Eighty-three participants entered the study as multiple domain MCI cases; 10 became normal, 46 remained MCI, and 27 progressed to dementia. Three of the 27 demented died with full necropsies performed (one case was progressive supranuclear palsy and two confirmed Alzheimer's disease with severe cerebral amyloid angiopathy (CAA)). Without serial measures, 1 in 8 MCI could be misclassified as "stable MCI" despite reverting to normal. The stable MCI cohorts did not benefit from practice effects though the normal subjects did. Applying Classification and Regression Tree (CART) analysis enabled prediction of the endpoint status of participants from baseline values with 78.6% accuracy. The fluctuating cognitive status of the multiple domain MCI cases implies a remitting pathologic process with elements of recovery consistent with a progressive microvasculopathy such as CAA.