Early Markers Of Alzheimer Disease

工作摘要：阿尔茨海默病(AD)是几种神经退行性疾病(痴呆症)中最常见的，主要发生在晚年，偶尔在60岁之前，但更常见的是70岁以后。这项研究调查了巴尔的摩老龄化纵向研究(BLSA)参与者的预期心理、神经和神经心理变化。对60岁及以上的参与者进行神经学和神经心理学检查，重复许多在年龄较小时对这些受试者进行的测试。疑似阿尔茨海默病的诊断遵循NINCDS-ADRDA标准。 部分研究人员研究了血压(BP)的横截面和纵向关系，包括线性和非线性关系，以及它与人口统计和生活方式变量与广泛认知功能的相互作用。来自巴尔的摩老龄化纵向研究的847名参与者(503名男性和344名女性)在11年里完成了一到七次的语言和非语言记忆、注意力、知觉-运动速度、执行功能和对峙命名的测试，以及对BP的临床评估。在调整了年龄、教育程度、性别、饮酒、吸烟状况、抑郁评分和使用降压药物后，混合效应回归模型显示，在非言语记忆和对峙命名测试中，收缩压与纵向变化之间存在非线性关系；在年龄较大(80岁)、收缩压较高的个体中，认知能力下降明显。跨测试阶段的横断面研究结果表明，血压和认知功能之间的U型和J型关系有所缓和。在受教育程度较低的人群中，高舒张压和低舒张压都与执行功能和对峙命名测试中的较差表现有关；在未服用药物(抗高血压药)的个体中，在知觉运动速度和对峙命名测试中表现较差；在老年人中，与执行功能测试相关。横截面线性关系包括不饮酒者的收缩压较高和非语言记忆较差，以及受教育程度较低的人较高的舒张压和较差的工作记忆。结果表明，血压与认知功能的横截面和纵向关系主要是非线性的，并受到年龄、教育程度和降压药物的调节。因此，有一些个体亚群可能成为降低血压或维持足够的脑血流灌注的靶点。

Summary of work: Alzheimer's disease (AD) is the most widespread among several neurological degenerative diseases (dementias) that occur principally at later ages, occasionally before 60, but more frequently after age 70. This study examines prospective psychological, neurological, and neuropsychological changes in participants from the Baltimore Longitudinal Study of Aging (BLSA). Neurological and neuropsychological examinations are administered to participants aged 60 and older, repeating many of the tests that were administered to these subjects at earlier ages. Diagnoses of probable Alzheimer's disease follow the NINCDS-ADRDA criteria. Section investigators examined cross-sectional and longitudinal relations, both linear and nonlinear, of blood pressure (BP) and its interaction with demographic and lifestyle variables to a broad spectrum of cognitive functions. Eight hundred forty-seven participants (503 men and 344 women) from the Baltimore Longitudinal Study of Aging completed tests of verbal and nonverbal memory, attention, perceptuo-motor speed, executive functions, and confrontation naming, and clinical assessment of BP on one to seven occasions over 11 years. Mixed-effects regression models, adjusted for age, education, gender, alcohol consumption, smoking status, depression scores, and use of antihypertensive medications, revealed nonlinear relations of systolic BP with longitudinal change on tests of nonverbal memory and confrontation naming; cognitive decline was apparent among older (80+ years) individuals with higher systolic BP. Cross-sectional findings, across testing sessions, indicated moderated U- and J- shaped relations between BP and cognitive function. Both high and low diastolic BP was associated with poorer performance on tests of executive function and confrontation naming among less-educated persons; with tests of perceptuo-motor speed and confrontation naming among unmedicated (antihypertensives) individuals; and with executive function among older individuals. Cross-sectional linear relations included higher systolic BP and poorer nonverbal memory in non-drinkers, and higher diastolic BP and poorer working memory among less-educated individuals. Results indicate that cross-sectional and longitudinal relations of BP to cognitive function are predominantly nonlinear and moderated by age, education, and antihypertensive medications. Thus, there are subgroups of individuals who might be targeted for BP reduction or perhaps maintenance of adequate cerebral perfusion.