Guarch J, Marcos T, Salamero M, Blesa R
Clinical Institute of Psychiatry and Psychology, Hospital Clínic de Barcelona, Spain.
Int J Geriatr Psychiatry. 2004 Apr;19(4):352-8. doi: 10.1002/gps.1074.
To identify neuropsychological markers able to predict evolution towards dementia, through the detection of differential neuropsychological characteristics in a group of subjects complaining of memory loss, in a longitudinal, two-year follow-up study.
Longitudinal and retrospective comparisons of neuropsychological performance in: (a) subjects complaining of memory loss who, after a two-year period, met neurological and clinical diagnostic criteria for probable AD, and (b) subjects from the same group who did not progress towards dementia. A sample of 43 subjects were administered a comprehensive neuropsychological battery evaluating orientation, logical-verbal and visuoperceptive reasoning, immediate and delayed verbal and visual memory, attention, learning, executive functions and semantic and phonemic verbal fluency.
Of the 43 subjects evaluated and then re-evaluated two years later, ten (23%) progressed to dementia according to the NINCS-ADRDA criteria for probable Alzheimer's disease. The neuropsychological performance of the rest of the subjects (n=33) over the two examinations was stable. In the retrospective analysis the principal differences between the two groups were found in the intensity of the initial memory deficits (WMS-R) and in the impairment of other cognitive areas in the dementia group: formation of concepts, vocabulary and similarities (WAIS), learning (WMS-R) and several executive functions.
The deficits in cognitive areas other than memory are significant in subjects with memory complaints who progress towards dementia within two years. Memory complaints represent a risk factor that is at least as important as actual memory loss. Recent proposals for adding descriptive labels to the diagnosis of Mild Cognitive Impairment (MCI) in order to reflect the neuropsychological functions impaired in addition to memory (Petersen, 2001a), may be decisive from the prognostic viewpoint.
在一项为期两年的纵向随访研究中，通过检测一组主诉记忆丧失的受试者的差异神经心理学特征，确定能够预测向痴呆症演变的神经心理学标志物。
对以下两组受试者的神经心理学表现进行纵向和回顾性比较：（a）主诉记忆丧失且在两年后符合可能的阿尔茨海默病（AD）神经学和临床诊断标准的受试者，以及（b）来自同一组但未发展为痴呆症的受试者。对43名受试者进行了全面的神经心理学测试，评估定向、逻辑语言和视觉感知推理、即时和延迟语言及视觉记忆、注意力、学习、执行功能以及语义和音素语言流畅性。
在43名接受评估并在两年后重新评估的受试者中，根据NINCS-ADRDA可能的阿尔茨海默病标准，有10名（23%）发展为痴呆症。其余受试者（n = 33）在两次检查中的神经心理学表现稳定。在回顾性分析中，两组之间的主要差异在于初始记忆缺陷的严重程度（韦氏记忆量表修订版）以及痴呆症组中其他认知领域的损害：概念形成、词汇和相似性（韦氏成人智力量表）、学习（韦氏记忆量表修订版）以及几种执行功能。
在两年内发展为痴呆症的主诉记忆丧失受试者中，除记忆外的认知领域缺陷很显著。主诉记忆丧失是一个至少与实际记忆丧失同样重要的风险因素。最近为轻度认知障碍（MCI）诊断添加描述性标签以反映除记忆外受损的神经心理学功能的提议（彼得森，2001a），从预后角度来看可能具有决定性意义。
