Neuropsychological Predictors of Rapidly Progressing Patients with Alzheimer's Disease
Neuropsychological Predictors of Rapidly Progressing Patients with Alzheimer's Disease
复制标题
DOI：
10.1159/000319533
复制
发表时间：
2010-01-01
影响因子：
2.4
通讯作者：
Palmer, Katie
中科院分区：
文献类型：
--
作者：
Musicco, Massimo;Salamone, Giovanna;Palmer, Katie
背景：阿尔茨海默病（Alzheimer disease，AD）临床表现多样. AD患者的不同神经心理学特征可能指示病理过程的扩散，并且可能与疾病进展速率的差异相关。方法：我们研究了154例新诊断的AD患者（65.6%为女性;平均年龄：73岁）。记忆、执行功能、实践和语言领域的表现分为轻度、中度和重度障碍。2年内简易精神状态检查（MMSE）评分丢失5分的时间依赖性概率被视为疾病进展，并通过生存分析进行评估。结果：1/4的患者在2年的随访中MMSE评分下降了65分。在受教育程度较高的患者和中度整体认知功能障碍患者中，疾病快速进展更为常见。在单变量分析中，更严重的记忆和执行功能障碍与更高的进展概率相关。在多变量分析中，执行功能障碍的差异仍具有统计学意义，这解释了与记忆的关联。结论：执行功能损害越严重的患者，2年以上的预后越差。这可能是由于在严重执行缺陷的患者中，前额叶皮层参与了AD的病理过程。版权所有（C）2010 S. Karger AG，巴塞尔
Background: Alzheimer disease (AD) has heterogeneous clinical manifestations. Different neuropsychological profiles in AD patients might be indicative of the diffusion of the pathological process and might be associated with differences in rates of disease progression. Methods: We studied 154 newly diagnosed AD patients (65.6% women; mean age: 73 years). Performance in memory, executive functions, praxis and language domains was categorized into mild, moderate and severe impairment. The time-dependent probability of losing 5 points on the Mini-Mental State Examination (MMSE) over 2 years was considered as disease progression and evaluated by survival analysis. Results: One fourth of the patients decreased by 65 MMSE points over the 2-year follow-up. Rapid disease progression was more frequent in more educated patients and in those with moderate severity of global cognitive impairment. In univariate analysis, more severe memory and executive functioning impairment were associated with higher probabilities of progression. The association with memory was explained by differences in executive function impairment that remained statistically significant in multivariate analyses. Conclusions: Patients with more severe executive functioning impairment have a worse prognosis over 2 years. This might be due to involvement of the prefrontal cortex by the pathological process of AD in patients with severe executive deficits. Copyright (C) 2010 S. Karger AG, Basel