Factors that predict cognitive decline in patients with subjective cognitive impairment
Factors that predict cognitive decline in patients with subjective cognitive impairment
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DOI：
10.1017/s1041610215000356
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发表时间：
2015-10-01
影响因子：
7
通讯作者：
Walker, Zuzana
中科院分区：
文献类型：
--
作者：
Fonseca, Jose Andres Saez;Ducksbury, Rhiannon;Walker, Zuzana
背景：目前的证据支持阿尔茨海默病(AD)临床前阶段的概念，即在无症状的个体中存在病理和影像变化。主观认知障碍(SCI)可能是AD发病过程中最早的时间点。更好地了解这组认知功能下降的患者的基线特征将增强我们对早期疾病过程的了解，有助于预防策略、早期诊断、及时随访和治疗。方法：对62例连续到记忆诊所就诊的脊髓损伤患者进行观察性探索性研究，比较认知功能下降患者和非认知功能衰退患者的基线特征。认知功能下降被定义为在随访时被诊断为遗忘性轻度认知损害(AMCI)或痴呆的进展。结果：患者获得了平均44个月(范围12-112个月)的随访。在随访时，24%的患者已经下降。下降的患者在出现症状和首次出现在记忆诊所时明显年龄较大，并明显更多地服用治疗身体疾病的药物。下降的患者在基线时的连线测验(TMT)B和剑桥认知考试修订版(CAMCOG-R)的表现也明显较差。生存分析确定了预测认知功能下降的关键变量(发病年龄较晚和首次评估的年龄较晚)。结论：有主观记忆主诉且年龄超过61岁的患者认知能力下降的风险很高，需要进行深入的评估和随访。
Background:Current evidence supports the concept of a preclinical phase of Alzheimer's disease (AD) where pathological and imaging changes are present in asymptomatic individuals. Subjective cognitive impairment (SCI) may represent the earliest point on the continuum of AD. A better understanding of the baseline characteristics of this group of patients that later decline in cognition will enhance our knowledge of the very early disease processes, facilitate preventive strategies, early diagnosis, timely follow-up and treatment.Methods:An observational exploratory study which followed up 62 consecutive patients with SCI presenting to a memory clinic and compared baseline characteristics of SCI patients who declined cognitively with those who did not. Cognitive decline was defined as a progression to a diagnosis of amnestic mild cognitive impairment (aMCI) or dementia at follow-up.Results:Patients were followed up for a mean of 44 months (range 12-112 months). At the time of follow up, 24% of patients had declined. Patients that declined were significantly older at onset of symptoms and first presentation to memory clinic, and took significantly more medications for physical illnesses. Patients that declined also performed significantly worse on Trail Making Test (TMT) B and Cambridge Cognitive Examination - Revised (CAMCOG-R) at baseline. Survival analysis identified key variables that predicted decline (later age of onset and later age at first assessment).Conclusions:Patients who present with subjective memory complaints and are over the age of 61 years are at high risk of cognitive decline and warrant an in-depth assessment and follow-up.