Alzheimer's Disease Progression: Factors Influencing Cognitive Decline
Alzheimer's Disease Progression: Factors Influencing Cognitive Decline
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DOI：
10.3233/jad-170665
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发表时间：
2018-01-01
影响因子：
4
通讯作者：
Sorbi, Sandro
中科院分区：
文献类型：
--
作者：
Ferrari, Camilla;Lombardi, Gemma;Sorbi, Sandro
背景：阿尔茨海默病（AD）患者的认知能力下降速度存在很大差异。尽管人们对影响痴呆风险的因素有了广泛的了解，但对于 AD 进展的原因却知之甚少。以往关于这一主题的研究主要是单独分析各个因素，没有考虑遗传因素和非遗传因素之间的相互作用。目的：本研究的目的是评估人口、临床、治疗和遗传因素及其相互作用对新诊断的 AD 患者认知能力下降的作用。方法：我们回顾性选取了 160 名在佛罗伦萨卡雷吉大学医院神经内科诊断的 AD 患者。我们评估了快速认知变化的发生情况，定义为两年随访后简易精神状态检查中恶化超过四分。结果：在 160 名 AD 患者中，50% 出现快速疾病进展。疾病发作时的锥体外系体征是预后较差的预测因素 (OR 2.2)，尤其是在载脂蛋白 E (APOE) epsilon 4 等位基因携带者中，而痴呆家族史的存在可将快速进展的风险降低约 50%。受过高等教育的 epsilon 4 携带者表现出 AD 进展较慢。我们确定长期使用阿司匹林作为非 epsilon 4 携带者潜在的二级预防策略。结论：在痴呆症发作时，一些临床和人口统计数据可以作为未来进展的预测因子。本研究的结果支持了疾病过程中遗传因素和非遗传因素之间已经假设的相互作用，并提出了基于遗传的方法。
Background: Alzheimer's disease (AD) patients present high variability in the rate of cognitive decline. Despite the wide knowledge on factors influencing dementia risk, little is known on what accounts for AD progression. Previous studies on this topic have mainly analyzed each factor separately without taking into account the interaction between genetic and non-genetic factors.Objective: The aim of the present study is to evaluate the role of demographic, clinical, therapeutic, and genetic factors and their interaction on cognitive decline among newly diagnosed AD patients.Methods: We retrospectively selected 160 AD patients diagnosed at the Neurology Unit of Careggi University Hospital of Florence. We evaluated the occurrence of rapid cognitive changes defined as the worsening of more than four points at the Mini-Mental State Examination after 2-year follow up period.Results: Among the 160 AD patients, 50% presented rapid disease progression. Extrapyramidal signs at disease onset were predictors of worse outcome (OR 2.2), especially among Apolipoprotein E (APOE) epsilon 4 allele carriers, while the presence of family history for dementia decreased the risk of rapid progression by about 50%. Higher educated epsilon 4-carriers showed a slower AD progression. We identified the chronic use of aspirin as potential secondary preventative strategy for the non epsilon 4-carriers.Conclusion: At dementia onset, some clinical and demographic data can be predictors of future progression. The outcomes of the present study support the already hypothesized interaction between genetic and non-genetic factors during disease course and suggest genetic-based approaches.