Olfactory deficits predict cognitive decline and Alzheimer dementia in an urban community
Olfactory deficits predict cognitive decline and Alzheimer dementia in an urban community
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DOI：
10.1212/wnl.0000000000001132
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发表时间：
2015-01-13
期刊：
影响因子：
9.9
通讯作者：
Mayeux, Richard
中科院分区：
文献类型：
--
作者：
Devanand, D. P.;Lee, Seonjoo;Mayeux, Richard
目的：确定基线气味识别缺陷对未来认知能力下降和阿尔茨海默病（AD）dementia.Methods诊断的预测效用：在纽约州北曼哈顿的一个多种族社区队列中，1,037名无痴呆的参与者进行了评估与40项宾夕法尼亚大学气味识别测试（UPSIT）。在757名参与者中，随访时间分别为2年和4年。结果：在logistic回归分析中，较低的基线UPSIT评分与认知能力下降相关（相对风险1.067/点区间; 95%置信区间[CI] 1.040，1.095; p < 0.0001），并保持显著性（相对风险1.065/点区间; 95% CI 1.034，1.095; p < 0.0001）。UPSIT，而不是选择性提醒测试-总即时回忆，预测没有基线认知障碍的参与者的认知下降。在随访期间，101名参与者转变为AD痴呆。在离散时间生存分析中，较低的基线UPSIT评分与向AD痴呆的转变相关（每个点间隔的风险比为1.099; 95%CI 1.067，1.131; p < 0.0001），并保持高度显著性（风险比1.072/点区间; 95%CI 1.036，1.109; p < 0.0001），包括人口统计学、认知和功能协变量后。在预测认知功能完好的参与者的认知能力下降方面，气味识别障碍上级言语情景记忆障碍。研究结果支持跨文化使用相对便宜的气味识别测试作为认知下降和AD痴呆的早期生物标志物。这种测试可能有潜力选择/分层的患者在治疗试验中的认知受损的患者或预防试验中的认知完整的个人。
Objective: To determine the predictive utility of baseline odor identification deficits for future cognitive decline and the diagnosis of Alzheimer disease (AD) dementia.Methods: In a multiethnic community cohort in North Manhattan, NY, 1,037 participants without dementia were evaluated with the 40-item University of Pennsylvania Smell Identification Test (UPSIT). In 757 participants, follow-up occurred at 2 years and 4 years.Results: In logistic regression analyses, lower baseline UPSIT scores were associated with cognitive decline (relative risk 1.067 per point interval; 95% confidence interval [CI] 1.040, 1.095; p < 0.0001), and remained significant (relative risk 1.065 per point interval; 95% CI 1.034, 1.095; p < 0.0001) after including covariates. UPSIT, but not Selective Reminding Test-total immediate recall, predicted cognitive decline in participants without baseline cognitive impairment. During follow-up, 101 participants transitioned to AD dementia. In discrete time survival analyses, lower baseline UPSIT scores were associated with transition to AD dementia (hazard ratio 1.099 per point interval; 95% CI 1.067, 1.131; p < 0.0001), and remained highly significant (hazard ratio 1.072 per point interval; 95% CI 1.036, 1.109; p < 0.0001) after including demographic, cognitive, and functional covariates.Conclusions: Impairment in odor identification was superior to deficits in verbal episodic memory in predicting cognitive decline in cognitively intact participants. The findings support the crosscultural use of a relatively inexpensive odor identification test as an early biomarker of cognitive decline and AD dementia. Such testing may have the potential to select/stratify patients in treatment trials of cognitively impaired patients or prevention trials in cognitively intact individuals.