Olfactory deficits in patients with mild cognitive impairment predict Alzheimer's disease at follow-up
Olfactory deficits in patients with mild cognitive impairment predict Alzheimer's disease at follow-up
复制标题
DOI：
10.1176/appi.ajp.157.9.1399
复制
发表时间：
2000-09-01
影响因子：
17.7
通讯作者：
Mayeux, R
中科院分区：
文献类型：
--
作者：
Devanand, DP;Michaels-Marston, KS;Mayeux, R
目的：本研究评估了嗅觉识别缺陷的预测效用与轻度认知功能障碍患者的后续诊断可能Alzheimer's disease.Method：90例门诊轻度认知功能障碍患者进行了检查，在6个月的时间间隔。每年检查匹配的健康对照受试者（N=45）。结果：轻度认知障碍患者的嗅觉评分低于健康对照组。77例患者进行了随访; 19例在2年内被诊断为阿尔茨海默病。嗅觉评分低的患者（小于或等于40分中的34分），以及嗅觉评分低的患者没有主观嗅觉问题，比其他患者更容易患阿尔茨海默病。在调整年龄、性别、改良的简易精神状态评分和教育的考克斯比例风险模型中，低嗅觉评分不能预测阿尔茨海默病的发展时间，但低嗅觉评分伴随着缺乏对嗅觉缺陷的认识可预测阿尔茨海默病的发展时间。当注意力或记忆力指标取代模型中的改良简易精神状态评分时，这种效果仍然存在。在具有高简易精神状态评分（大于或等于30分中的27分）的患者中，嗅觉减退伴缺乏意识仍然是阿尔茨海默病的重要预测因素。嗅觉评分为30-35表现出中度到强烈的敏感性和特异性诊断阿尔茨海默病在follow-up.Conclusions：在轻度认知功能障碍的患者，嗅觉识别缺陷，特别是缺乏意识的嗅觉缺陷，可能有临床效用作为阿尔茨海默病的早期诊断标志物。
Objective: This study evaluated the predictive utility of olfactory identification deficits in patients with mild cognitive impairment for follow-up diagnosis of probable Alzheimer's disease.Method: Ninety outpatients with mild cognitive impairment were examined at 6-month intervals. Matched healthy comparison subjects (N=45) were examined annually. The University of Pennsylvania Smell Identification Test was given at baseline.Results: Olfaction scores were lower in patients with mild cognitive impairment than in healthy comparison subjects. Seventy-seven patients were followed up; 19 were diagnosed with Alzheimer's disease by 2 years. Patients with low olfaction scores (less than or equal to 34 of 40), and patients with low olfaction scores who reported no subjective problems smelling, were more likely to develop Alzheimer's disease than other patients. In a Cox proportional hazards model adjusted for age, sex, modified Mini-Mental State score, and education, low olfaction scores did not predict time until development of Alzheimer's disease, but low olfaction scores accompanied by lack of awareness of olfactory deficits predicted time to development of Alzheimer's disease. This effect remained when attention or memory measures replaced modified Mini-Mental State score in the model. In patients with high Mini-Mental State scores (greater than or equal to 27 of 30), low olfaction with lack of awareness remained a significant predictor of Alzheimer's disease. Olfaction scores of 30-35 showed moderate to strong sensitivity and specificity for diagnosis of Alzheimer's disease at follow-up.Conclusions: In patients with mild cognitive impairment, olfactory identification deficits, particularly with lack of awareness of olfactory deficits, may have clinical utility as an early diagnostic marker for Alzheimer's disease.