Daily Functioning, Cognition, and Caregiver Burden in MCI Patients

处于早期痴呆症（最常见的是阿尔茨海默病）阶段的个体被称为轻度认知障碍（MCI）。然而，具体的临床诊断标准尚未建立，因为认知和日常功能障碍尚未在轻度认知障碍患者中得到很好的表征。目前的研究标准表明，MCI患者必须表现出超过正常衰老的记忆障碍，并保持相对保留的日常功能能力（Petersen, 2004）。然而，最近的研究表明，轻度认知损伤患者可能会经历细微的功能障碍（Farias et al., 2009; Pernesczky et al., 2006a）。问题是，大多数评估日常功能的研究要么使用认知评定形式，要么使用自我评定或被调查者评定的日常生活工具活动，这可能导致有偏差的结果（Albert等人，1999；Wadley等人，2003；Razani等人，2007）。此外，很少有人关注轻度认知障碍患者的照顾者，因为有一种假设认为轻度认知障碍患者在日常活动中不需要帮助。因此，本研究的目的是：1)使用基于表现的测量来表征MCI个体的日常功能，并检查相对于诊断为痴呆的MCI患者，神经心理损伤如何影响MCI患者的功能能力；2)表征神经心理和功能损伤如何影响MCI个体的照顾者。3)评估认知衰退率是否可以预测MCI个体功能衰退率及其照顾者负担增加率。将招募40名轻度认知障碍患者（使用当前的轻度认知障碍研究诊断标准），并对他们进行临床神经心理学测试，包括记忆力、注意力、抽象推理和信息处理速度测试，以及基于性能的功能任务。MCI患者的表现将与痴呆患者（阿尔茨海默病、额颞叶痴呆和血管性痴呆）和正常对照者的数据库进行比较。此外，将对家属进行一套问卷调查，以评估所经历的负担和心理困扰的程度。患者和护理人员将在基线和1年随访期间进行测试。将比较各组的功能能力，检查神经心理学测试分数对日常功能的预测程度，最后评估1年内认知和功能能力的下降情况。研究结果将更好地描述轻度认知损伤患者及其护理人员所经历的程度、类型和严重程度，这将有助于完善轻度认知损伤的诊断标准，并为患者及其家属提供更好的治疗计划。

Individuals at the very early stages of dementia (most often Alzheimer's disease) are referred to as having mild cognitive impairment (MCI). However, concrete clinical diagnostic criteria have not yet been established because cognitive and daily functional impairments are not yet well characterized in individuals with MCI. The current research criteria states that individuals with MCI must exhibit memory impairment beyond that of normal aging and maintain relatively preserved daily functional abilities (Petersen, 2004). Yet, recent research indicates that MCI patients are likely to experience subtle functional impairments (Farias et al., 2009; Pernesczky et al., 2006a). The problem is that most of the studies assessing daily functioning have used either cognitive rating forms or self- or informant-rated instrumental activities of daily living which can lead to biased results (Albert et al., 1999; Wadley et al., 2003; Razani et al., 2007). Additionally, very little attention has been paid to caregiver's of MCI individuals, given that there is an assumption that individuals with MCI do not require assistance in their daily activities. Thus, the aims of the present study are. 1) to characterize daily functioning in MCI individuals using a performance-based measure and to examine how neuropsychological impairment affects functional ability in MCI patients relative to those with diagnosed dementia, 2) to characterize how neuropsychological and functional impairments affect caregivers of MCI individuals, and 3) to assess whether the rate of cognitive decline can predict the rate of functional decline in MCI individuals and the rate of increased burden for their caregivers. Forty individuals with MCI (using the current research diagnostic criteria for MCI) will be recruited and administered a clinical neuropsychological test battery that includes tests of memory, attention, abstract reasoning, and information processing speed, as well as a performance-based functional task. The performance of the MCI individuals will be compared to a database of individuals with dementia (Alzhiemer's disease, Frontotemporal dementia, and Vascular dementia) and normal controls. Additionally, next-of-kin caregivers will be administered a set of questionnaires in order to assess the level of burden and psychological distress experienced. Patients and caregivers will be administered tests at baseline and 1-year follow-up periods. The functional abilities of the groups will be compared, the degree to which neuropsychological test scores predict daily functioning will be examined, and finally decline in cognitive and functional abilities over a 1-year period will be assessed. The results will better characterize degree, type and severity of deficits experienced by MCI individuals and their caregivers, which will assist with refining the diagnostic criteria for MCI and lead to better treatment planning for patients and their families.