Quantification of five neuropsychological approaches to defining mild cognitive impairment.
Quantification of five neuropsychological approaches to defining mild cognitive impairment.
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DOI：
10.1097/jgp.0b013e31819431d5
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Delis DC
中科院分区：
文献类型：
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作者：
Jak AJ;Bondi MW;Delano-Wood L;Wierenga C;Corey-Bloom J;Salmon DP;Delis DC
在诊断轻度认知功能障碍（MCI）时，认知功能障碍的操作定义有很大差异。MCI的临床亚型的确定进一步挑战了诊断方法，因为客观认知评估的组成部分的变化可能会显着影响诊断。因此，我们研究了MCI临床亚型诊断标准在社区老年人自然研究样本中的适用性，并量化了由于修改客观认知障碍的神经心理学定义而导致的诊断结果的变异性。横截面和纵向研究圣地亚哥，加利福尼亚州，退伍军人管理局医院90名非痴呆，神经正常，社区居住的老年人进行了初步评估，73人被视为随访约17个月后。参与者通过共识诊断被分类为正常衰老或通过五种诊断策略中的每一种诊断策略患有MCI，这改变了客观损伤的截止值以及诊断过程中考虑的神经心理学测试的数量。根据所采用的分类标准，MCI与认知正常的百分比存在一系列差异。随着时间的推移，以及在不同的诊断方法中，有相当一部分人表现出诊断不稳定性。单域非遗忘亚型诊断特别不稳定（例如，在随访时倾向于重新分类为正常）。我们的研究结果为MCI临床亚型的神经心理学操作定义提供了经验支持，并指出了使用全面神经心理学评估的重要性。诊断，特别是涉及非遗忘型MCI，随时间变化。这种特定MCI亚型的适用性和实用性值得进一步研究。
Operational definitions of cognitive impairment have varied widely in diagnosing mild cognitive impairment (MCI). Identifying clinical subtypes of MCI has further challenged diagnostic approaches, since varying the components of the objective cognitive assessment can significantly impact diagnosis. Therefore, we investigated the applicability of diagnostic criteria for clinical subtypes of MCI in a naturalistic research sample of community elders and quantified the variability in diagnostic outcomes that results from modifying the neuropsychological definition of objective cognitive impairment. Cross-sectional and longitudinal study San Diego, CA, Veterans Administration Hospital 90 nondemented, neurologically normal, community-dwelling older adults were initially assessed and 73 were seen for follow-up approximately 17 months later. Participants were classified via consensus diagnosis as either normally aging or having MCI via each of five diagnostic strategies, which varied the cutoff for objective impairment as well as the number of neuropsychological tests considered in the diagnostic process. A range of differences in the percentages identified as MCI versus cognitively normal were demonstrated, depending on the classification criteria employed. A substantial minority of individuals demonstrated diagnostic instability over time as well as across diagnostic approaches. The single domain non-amnestic subtype diagnosis was particularly unstable (e.g., prone to reclassification as normal at follow up). Our findings provide empirical support for a neuropsychologically derived operational definition of clinical subtypes of MCI and point to the importance of using comprehensive neuropsychological assessments. Diagnoses, particularly involving non-amnestic MCI, were variable over time. The applicability and utility of this particular MCI subtype warrants further investigation.