Risk Factors and Pathological Substrates Associated with Agitation/Aggression in Alzheimer's Disease: A Preliminary Study using NACC Data.
Risk Factors and Pathological Substrates Associated with Agitation/Aggression in Alzheimer's Disease: A Preliminary Study using NACC Data.
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DOI：
10.3233/jad-160780
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Munoz DG
中科院分区：
文献类型：
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作者：
Sennik S;Schweizer TA;Fischer CE;Munoz DG
神经精神症状是阿尔茨海默病（AD）的常见表现。许多研究都针对精神病，即 AD 中的幻觉和妄想，但很少有研究评估 AD 中的激越/攻击行为。旨在调查尸检证实的 AD 中与激越/攻击性 (A) 存在 [A(+)] 和不存在 [A(−)] 相关的危险因素和病理基础。数据收集自 NACC 数据库截至 2015 年的 UDS 数据。患者被分为中度（IAD）或高度（HAD）AD 病理负荷。不考虑临床诊断；额外的病理诊断被视为变量。数据分析不包括对照组或多重比较的校正。 1,716 名患者符合资格标准； 34.6% 的 IAD 和 49.6% 的 HAD 患者为 A(+)，表明与病理严重程度相关 (p = 0.001)。 A(+) 的危险因素包括：初次就诊时的年龄、死亡时的年龄、受教育年限、吸烟（女性）、近期心脏事件（男性）和创伤性脑损伤 (TBI) 的临床病史（男性）。高血压病史与A(+)无关。在合并症方面，路易体痴呆综合征的临床诊断与A(+)相关，但以路易体表现的病理诊断为标准时，这种关联并未得到证实。磷酸化 TDP-43（而非 tau 病理学）的额外存在与 A(+)HAD 相关。血管病变，包括腔隙、大动脉梗塞和动脉粥样硬化的严重程度与 A(+) 呈负相关。相关症状包括妄想、幻觉和抑郁，但不包括烦躁、异常运动行为、睡眠和夜间行为改变或食欲和饮食习惯改变。吸烟、TBI 和磷酸化 TDP-43 分别与特定组中的 A(+)AD 相关。 A(+) 与 AD 病理负荷直接相关，与血管病变成反比。
Neuropsychiatric symptoms are common manifestations of Alzheimer’s disease (AD). A number of studies have targeted psychosis, i.e., hallucinations and delusions in AD, but few have assessed agitation/aggression in AD. To investigate the risk factors and pathological substrates associated with presence [A(+)] and absence [A(−)] of agitation/aggression (A) in autopsy-confirmed AD. Data was collected from the UDS data as of 2015 on the NACC database. Patients were stratified as intermediate (IAD) or high (HAD) pathological load of AD. Clinical diagnoses were not considered; additional pathological diagnoses were treated as variables. Analysis of data did not include a control group or corrections for multiple comparisons. 1,716 patients met the eligibility criteria; 34.6% of the IAD and 49.6% of the HAD patients were A(+), indicating an association with severity of pathology (p = 0.001). Risk factors for A(+) included: age at initial visit, age at death, years of education, smoking (in females), recent cardiac events (in males), and clinical history of traumatic brain injury (TBI) (in males). A history of hypertension was not related to A(+). In terms of comorbidity, clinical diagnosis of Lewy body dementia syndrome was associated with A(+)but the association was not confirmed when pathological diagnosis based on demonstration of Lewy bodies was used as the criterion. The additional presence of phosphorylated TDP-43, but not tau pathologies, was associated with A(+)HAD. Vascular lesions, including lacunes, large arterial infarcts, and severity of atherosclerosis were negatively associated with A(+). Associated symptoms included delusions, hallucinations, and depression, but not irritability, aberrant motor behavior, sleep and night time behavioral changes, or changes in appetite and eating habits. Smoking, TBI, and phosphorylated TDP-43 are associated with A(+)AD in specific groups, respectively. A(+) is directly associated with AD pathology load and inversely with vascular lesions.