The Added Value of Global Amyloid Burden in Predicting Cognition in the MEMENTO Cohort
The Added Value of Global Amyloid Burden in Predicting Cognition in the MEMENTO Cohort
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整体淀粉样蛋白负担在预测 MMENTO 队列认知中的附加值
DOI：
10.1002/alz.063459
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Ackley S
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作者：
Ackley S
背景全淀粉样蛋白-PET 与认知和认知能力下降有关，但大多数关于这种关联的研究并未考虑过去的认知信息。当先前的认知评估可用时，我们评估了淀粉样蛋白-PET测量对未来认知的预后益处，评估了淀粉样蛋白测量在过去多次认知评估信息之外的附加值。方法法国Memento队列（来自法国研究记忆中心的门诊患者队列，旨在通过DPUK提高对阿尔茨海默病和相关疾病的了解）包括早期认知变化但没有痴呆诊断的老年门诊患者。在基线或随访期间，使用正电子发射断层扫描（淀粉样蛋白-PET）对一部分参与者的总体淀粉样蛋白负荷进行评估；随后进行半年一次的认知测试。我们的分析样本包括 488 名接受过淀粉样蛋白 PET 扫描且至少有 4 次后续简易精神状态检查 (MMSE) 评分的个体。我们单独使用人口特征（年龄、性别、婚姻状况和教育程度）或结合先前认知测量的信息来预测 MMSE 分数。在这些模型中将淀粉样蛋白负荷作为预测因子的附加价值通过均方误差 (MSE) 的减少百分比进行评估。所有模型均单独进行，以评估二分淀粉样蛋白阳性状态与连续淀粉样蛋白标准化摄取值比相比的附加值。结果将淀粉样蛋白负担添加到仅调整人口特征的模型中，使预测的 MSE 降低了 6.35%（95% CI：[1.50%，12.63%]）和 12.04%（95% CI：[3.37%，22.48%]）分别是二元淀粉样蛋白和连续淀粉样蛋白。如果模型包含过去的一项 MMSE 测量，则在添加二元淀粉样蛋白时，MSE 改善仅为 4.08%（95% CI：[1.12%，7.93%]）；在添加连续淀粉样蛋白时，MSE 改善仅为 7.87%（95% CI：[2.46%，13.92%]）。当包含不止一项过去的认知评估时，添加淀粉样蛋白负担时，模型拟合的改善甚至更小。对于纳入一项或多项过去认知评估的模型，与添加淀粉样蛋白信息相关的预测差异平均只有一个 MMSE 点的一小部分。结论当过去的认知评估可用时，全局淀粉样蛋白负担并没有明显改善认知预测。
BackgroundGlobal amyloid‐PET is associated with cognition and cognitive decline, but most research on this association does not account for past cognitive information. We assessed the prognostic benefit of amyloid‐PET measures for future cognition when prior cognitive assessments are available, evaluating the added value of amyloid measures beyond information on multiple past cognitive assessments.MethodThe French MEMENTO cohort (a cohort of outpatients from French research memory centers in order to improve knowledge on Alzheimer’s disease and related disorders, via DPUK) includes older outpatients with incipient cognitive changes, but no dementia diagnosis at inclusion. Global amyloid burden was assessed using positron emission tomography (amyloid‐PET) for a subset of participants at baseline or during follow up; semiannual cognitive testing was subsequently performed. Our analytic sample included 488 individuals who underwent amyloid‐PET scans and with at least 4 subsequent mini‐mental state examination (MMSE) scores available. We predicted MMSE scores using demographic characteristics (age, sex, marital status, and education) alone or in combination with information on prior cognitive measures. The added value of including amyloid burden as a predictor in these models was evaluated by the percent reduction of the mean‐squared error (MSE). All models were conducted separately for evaluating the added value of dichotomous amyloid positivity status compared to continuous amyloid standardized uptake‐value ratio.ResultAdding amyloid burden to a model adjusting for only demographic characteristics reduced the MSE of predictions by 6.35% (95% CI: [1.50%, 12.63%]) and 12.04% (95% CI: [3.37%, 22.48%]) for binary and continuous amyloid, respectively. If the model included one past MMSE measure, the MSE improvement was only 4.08% (95% CI: [1.12%, 7.93%]) when adding binary amyloid and 7.87% (95% CI: [2.46%, 13.92%]) when adding continuous amyloid.Improvements in model fit were even smaller with the addition of amyloid burden when more than one past cognitive assessment was included. For models incorporating one or more past cognitive assessments, differences in predictions associated with adding information about amyloid amounted to a fraction of one MMSE point on average.ConclusionGlobal amyloid burden did not appreciably improve cognitive predictions when past cognitive assessments were available.