Progression to dementia in memory clinic patients without dementia A latent profile analysis
Progression to dementia in memory clinic patients without dementia A latent profile analysis
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DOI：
10.1212/wnl.0b013e3182a82536
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发表时间：
2013-10-08
期刊：
影响因子：
9.9
通讯作者：
Ramakers, Inez
中科院分区：
文献类型：
--
作者：
Kohler, Sebastian;Hamel, Renske;Ramakers, Inez
目的：探讨非痴呆记忆门诊患者认知亚型的存在及其预后价值。方法：对马斯特里赫特或阿姆斯特丹阿尔茨海默病中心就诊的635例非痴呆患者进行回顾性队列研究，通过潜伏期分析确定认知亚型，包括即刻和延迟记忆回忆、延迟再认、信息处理速度、注意力、言语流畅性和执行功能。结果：5个潜在类别分别代表高-正常认知(15%)、低-正常认知(37%)、回忆中的初级记忆损害(MI)(36%)、回忆与再认中的记忆损害(MI+)(5%)和原发性非记忆损害(NMI)(6%)。与低认知水平的参与者相比，NMI患者患痴呆的风险最高(危险比=5.94，95%可信区间=3.46~10.18)，其次是MI(HR=3.05，95%CI=2.09~4.46)和MI+(HR=3.26，95%CI=1.72~6.17)，而高认知水平的参与者患痴呆的风险最低(HR=0.24，95%CI=0.07~0.80)。亚型与痴呆类型进一步表现出不同的关系，MI和MI+最常转化为阿尔茨海默型痴呆，NMI最常转化为其他形式的痴呆。结论：认知亚型可以在其他不同的记忆临床患者样本中得到经验识别，并在很大程度上证实了当前区分遗忘性和非遗忘性损害的策略。研究更多同质性的认知亚型可能会提高对疾病机制和结果的理解。
Objective: To identify the existence of discrete cognitive subtypes among memory clinic patients without dementia and test their prognostic values.Methods: In a retrospective cohort study of 635 patients without dementia visiting the Alzheimer centers in Maastricht or Amsterdam, latent profile analysis identified cognitive subtypes based on immediate and delayed memory recall, delayed recognition, information-processing speed, attention, verbal fluency, and executive functions. Time to dementia was tested in weighted Cox proportional hazard models adjusted for confounders.Results: Five latent classes represented participants with high-normal cognition (15%), low-normal cognition (37%), primary memory impairment in recall (MI) (36%), memory impairment in recall and recognition (MI+) (5%), and primary nonmemory impairment (NMI) (6%). Compared with low-normal cognition, participants with NMI had the highest risk of dementia (hazard ratio [HR] = 5.94, 95% confidence interval [CI] = 3.46-10.18) followed by MI (HR = 3.05, 95% CI = 2.09-4.46) and MI+ (HR = 3.26, 95% CI = 1.72-6.17), while participants with high-normal cognition had the lowest risk (HR = 0.24, 95% CI = 0.07-0.80). Subtypes further showed differential relationships with dementia types, with MI and MI+ most often converting to Alzheimer-type dementia and NMI to other forms of dementia.Conclusions: Cognitive subtypes can be empirically identified in otherwise heterogeneous samples of memory clinic patients and largely confirm current strategies to distinguish between amnestic and nonamnestic impairment. Studying more homogeneous cognitive subtypes may improve understanding of disease mechanisms and outcomes.