Neuropsychological Decline Stratifies Dementia Risk in Cognitively Unimpaired and Impaired Older Adults.
Neuropsychological Decline Stratifies Dementia Risk in Cognitively Unimpaired and Impaired Older Adults.
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DOI：
10.3389/fnagi.2022.838459
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发表时间：
2022
影响因子：
4.8
通讯作者：
中科院分区：
文献类型：
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作者：
尽管在预后和治疗决策方面具有潜在价值，但系列神经心理学检查中指示下降的标记物的验证和广泛使用仍然难以捉摸。本研究旨在对老年人进行为期12个月的神经心理学衰退（称为“神经心理学（NP）衰退”）的操作化，以帮助将痴呆风险沿着认知未受损至轻度认知障碍（MCI）谱分层。一项前瞻性队列研究使用了来自国家阿尔茨海默病协调中心（NACC）数据库的6，794名老年人，基线诊断为正常认知，无MCI或MCI受损。在12个月的随访中，NP下降的操作使用了在稳健正常参考样本中开发的基于回归的规范。每个参与者的12个月随访评分偏离正常参考预期的程度被量化并标准化为NP下降z评分。考克斯回归评估NP下降指标是否预测未来的痴呆。参与者的NP下降评分预测了总样本中未来的全因痴呆，χ2 = 110.71，风险比（HR）= 1.989，p < 0.001，在诊断为认知正常的子集中，χ2 = 40.84，HR = 2.006，p < 0.001，未诊断为MCI的受损，χ2 = 14.89，HR = 2.465，P < 0.001，MCI诊断受损，χ2 = 55.78，HR = 1.916，P < 0.001。使用基于回归的标准化方法在12个月内操作NP下降，可以进一步将痴呆风险沿着认知未受损的MCI谱分层。使用NP下降作为超出标准认知诊断实践的风险的连续性标志物可能有助于预后和临床决策。
Validation and widespread use of markers indicating decline in serial neuropsychological exams has remained elusive despite potential value in prognostic and treatment decision-making. This study aimed to operationalize neuropsychological decline, termed “neuropsychological (NP) decline,” in older adults followed over 12 months in order to aid in the stratification of dementia risk along the cognitively unimpaired-to-mild cognitive impairment (MCI) spectrum. A prospective cohort study utilized 6,794 older adults from the National Alzheimer’s Coordinating Center (NACC) database with a baseline diagnosis of normal cognition, impaired without MCI or with MCI. Operationalization of NP decline over 12-month follow-up used regression-based norms developed in a robustly normal reference sample. The extent to which each participant’s 12-month follow-up score deviated from norm-referenced expectations was quantified and standardized to an NP decline z-score. Cox regression evaluated whether the NP decline metric predicted future dementia. Participant’s NP decline scores predicted future all-cause dementia in the total sample, χ2 = 110.71, hazard ratio (HR) = 1.989, p < 0.001, and in the subset diagnosed with normal cognition, χ2 = 40.84, HR = 2.006, p < 0.001, impaired without MCI diagnosis, χ2 = 14.89, HR = 2.465, p < 0.001, and impaired with MCI diagnosis, χ2 = 55.78, HR = 1.916, p < 0.001. Operationalizing NP decline over 12 months with a regression-based norming method allows for further stratification of dementia risk along the cognitively unimpaired-to-MCI spectrum. The use of NP decline as an adjunctive marker of risk beyond standard cognitive diagnostic practices may aid in prognosis and clinical decision-making.
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影响因子：
7.2
作者：
Duff, Kevin;Lyketsos, Constantine G.;McCaffrey, Robert J.
通讯作者：
McCaffrey, Robert J.
影响因子：
29
作者：
Donohue, Michael C.;Sperling, Reisa A.;Salmon, David P.;Rentz, Dorene M.;Raman, Rema;Thomas, Ronald G.;Weiner, Michael;Aisen, Paul S.
通讯作者：
Aisen, Paul S.
影响因子：
7
作者：
Duff, Kevin;Beglinger, Leigh J.;Paulsen, Jane S.
通讯作者：
Paulsen, Jane S.
影响因子：
4
作者：
Nation, Daniel A.;Ho, Jean K.;Lai, Mark H. C.
通讯作者：
Lai, Mark H. C.
DOI：
10.1017/s135561771400068x
发表时间：
2014-09
期刊：
Journal of the International Neuropsychological Society : JINS
影响因子：
--
作者：
Edmonds EC;Delano-Wood L;Galasko DR;Salmon DP;Bondi MW;Alzheimer’s Disease Neuroimaging Initiative
通讯作者：
Alzheimer’s Disease Neuroimaging Initiative