Patterns of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Risk of Dementia.
Patterns of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Risk of Dementia.
复制标题
DOI：
10.1016/j.jagp.2015.05.007
复制
发表时间：
2016-02
期刊：
影响因子：
--
通讯作者：
Leoutsakos JM
中科院分区：
文献类型：
--
作者：
Forrester SN;Gallo JJ;Smith GS;Leoutsakos JM
根据神经精神症状 (NPS) 识别发生轻度认知障碍的患者群，并根据这些群检查进展为痴呆的风险。队列研究，中位随访时间为 2 年。地点：国家阿尔茨海默病协调中心 (NACC) 的阿尔茨海默病中心。年龄至少 60 岁且具有完整数据和随访的 MCI 患者 (n = 540)。潜在类别分析用于根据患者的 NPS 来识别患者群，Cox 比例风险模型用于根据聚类检查进展为痴呆的风险。事件 MCI 被定义为参与者在当前就诊时患有 MCI，但在上次（每年）就诊时认知能力正常。 NPI-Q 评估了十二个神经精神行为领域的存在。确定了三个集群：严重集群（激动、焦虑、冷漠、夜间行为、抑制）、情感集群（抑郁、焦虑、易怒、夜间行为）和无症状集群。无症状类别的患病率为 56%，其次是情感类别（37%），最后是严重类别（7%）。与无症状类别相比，严重类别进展为痴呆的风险是其两倍多（2.69，CI：1.12–2.70），情感类别进展为痴呆的风险是其一倍半以上（1.79，CI：1.12–2.70）。在患有 MCI 的人中，NPS 模式可能会增加进展为痴呆的可能性。讨论了早期检测和治疗的意义。
To identify clusters of patients with incident mild cognitive impairment based on their neuropsychiatric symptoms (NPS) and to examine the risk of progression to dementia, based on these clusters. Cohort study with 2 years median length follow-up. Setting: Alzheimer’s disease Centers from the National Alzheimer’s Coordinating Center (NACC). Patients with MCI who were at least 60 years old with complete data and follow-up (n = 540). Latent class analysis was used to identify clusters of patients based on their NPS, and Cox proportional hazards models were used to examine risk of progression to dementia based on clusters. Incident MCI was defined as a participant having MCI at a current visit, but having been cognitively normal at his or her previous (yearly) visit. NPI-Q assessed presence of twelve neuropsychiatric behavioral domains. Three clusters were identified: a severe cluster (agitation, anxiety, apathy, nighttime behaviors, inhibition), an affective cluster (depression, anxiety, irritability, nighttime behaviors), and an asymptomatic cluster. The prevalence of each class was 56% for the asymptomatic class followed by the affective class (37%) and finally the severe class (7%). Compared to the asymptomatic class, the severe class had more than twice the hazard of progression to dementia (2.69, CI: 1.12–2.70) and the affective class had over one and a half times the hazard of progression to dementia (1.79, CI: 1.12–2.70). Among persons with incident MCI, patterns of NPS may increase the likelihood of progression to dementia. Implications for early detection and treatment are discussed.