Longitudinal course and neuropathologic outcomes in original vs revised MCI and in pre-MCI
Longitudinal course and neuropathologic outcomes in original vs revised MCI and in pre-MCI
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DOI：
10.1212/01.wnl.0000228231.26111.6e
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发表时间：
2006-08-08
期刊：
影响因子：
9.9
通讯作者：
Morris, John C.
中科院分区：
文献类型：
--
作者：
Storandt, Martha;Grant, Elizabeth A.;Morris, John C.
目的：比较根据原始标准分类为轻度认知障碍（MCI）的个体的自然史与根据修订的MCI标准分类的个体的自然史。研究方法：作者根据修订后的标准比较了32名遗忘型MCI患者和90名MCI患者的进展率，该标准允许276名受损程度太低（MCI前）而不符合MCI标准的非遗忘缺陷伴进展。本研究中的所有个体在临床上被确定为非常轻度的认知障碍，临床痴呆评分（CDR）为0.5。结果：两个MCI组的进展率相似，心理测量综合评分每年下降近0.50 SD。MCI前组下降较少（0.23 SD）。原始（95% CI：3.79至4.07年）和修订（95% CI：3.29至5.40）标准MCI组至CDR 1（轻度痴呆）的中位生存时间相当，但MCI前组约为2倍（95% CI：6.72至8.93）。所有来自遗忘型MCI标准组的神经病理学诊断的病例符合阿尔茨海默病的标准，其他两组中超过90%的病例符合阿尔茨海默病的标准。结论：最初和目前定义的轻度认知障碍通常是早期阿尔茨海默病，其可以开始为记忆以外的认知缺陷。通过关注个体内的变化而不是与群体标准进行比较，有可能在比轻度认知障碍更早的阶段识别阿尔茨海默病。
Objectives: To compare the natural history of individuals classified with mild cognitive impairment (MCI) in accordance with original criteria to the natural history of individuals classified with revised MCI criteria. Methods: The authors compared the rates of progression in 32 individuals with amnestic MCI and in 90 people with MCI according to revised criteria that allow nonamnestic deficits with progression in 276 individuals who were too minimally impaired (pre-MCI) to meet either MCI criteria. All individuals in this study were determined clinically to be very mildly cognitively impaired with a Clinical Dementia Rating (CDR) of 0.5. Results: Rates of progression for the two MCI groups were similar with a decline of almost 0.50 SD per year on a psychometric composite. Decline was less (0.23 SD) in the pre-MCI group. Median survival time to CDR 1 ( mild dementia) was comparable for the original (95% CI: 3.79 to 4.07 years) and revised ( 95% CI: 3.29 to 5.40) criteria MCI groups but approximately twice as long in the pre-MCI group ( 95% CI: 6.72 to 8.93). All cases from the amnestic MCI criteria group with neuropathologic diagnoses met criteria for Alzheimer disease as did more than 90% in the other two groups. Conclusions: Mild cognitive impairment as originally and currently defined is usually early stage Alzheimer disease, which can begin with a cognitive deficit other than memory. It is possible to identify Alzheimer disease at an even earlier stage than mild cognitive impairment by focusing on intraindividual change rather than comparison with group norms.