Dufouil Carole, Fuhrer Rebecca, Alpérovitch Annick
Institut National de la Santé et de la Recherche Médicale Unit 360, Epidemiological research in neurology and psychopathology, Hôpital La Salpêtrière, 75651 Paris Cedex 13, France.
J Am Geriatr Soc. 2005 Apr;53(4):616-21. doi: 10.1111/j.1532-5415.2005.53209.x.
To explore whether more cognitive complaints are associated with previous or future cognitive decline.
Longitudinal; epidemiology vascular aging study.
Community in Nantes, France.
Seven hundred thirty-three subjects, aged 59 to 71.
Subjective cognitive complaints were recorded at 4-year follow-up examination in a prospective study of people aged 59 to 71 at study entry. Participants' cognitive performances were assessed repeatedly at each wave (baseline, 4 years, and 6 years) of the study using a series of neuropsychological tests including the Mini-Mental State Examination. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale. Subjects also had a cerebral magnetic resonance imaging scan at 4-year follow-up to evaluate presence and severity of white matter hyperintensities (WMHs).
Subjects with more cognitive complaints had greater cognitive decline. This significant relationship persisted after adjusting for potential confounders, including depressive symptoms. Multivariate analysis also showed that, in subjects without measured cognitive decline between study entry and 4-year follow-up, those with more cognitive complaints at 4-year follow-up had significantly greater measured cognitive decline during the subsequent 2 years. In the presence of severe WMH, more cognitive complaints were an even stronger predictor of future cognitive decline.
Cognitive complaints reflect measured cognitive decline, but they also predict cognitive decline at an earlier stage than objective tests that are not able to detect cognitive deficits. They need to be taken into account in clinical practice.
探讨更多的认知主诉是否与既往或未来的认知衰退相关。
纵向研究；血管性衰老流行病学研究。
法国南特的社区。
733名年龄在59至71岁之间的受试者。
在一项对研究开始时年龄为59至71岁人群的前瞻性研究中，在4年随访检查时记录主观认知主诉。在研究的每个阶段（基线、4年和6年），使用包括简易精神状态检查表在内的一系列神经心理学测试对参与者的认知表现进行反复评估。使用流行病学研究中心抑郁量表评估抑郁症状。受试者在4年随访时还进行了脑磁共振成像扫描，以评估白质高信号（WMH）的存在和严重程度。
认知主诉较多的受试者认知衰退更严重。在对包括抑郁症状在内的潜在混杂因素进行调整后，这种显著关系依然存在。多变量分析还显示，在研究开始至4年随访期间未测量到认知衰退的受试者中，4年随访时认知主诉较多的受试者在随后2年中测量到的认知衰退明显更严重。在存在严重WMH的情况下，更多的认知主诉是未来认知衰退更强的预测指标。
认知主诉反映了测量到的认知衰退，但它们也比无法检测到认知缺陷的客观测试更早地预测认知衰退。在临床实践中需要考虑到它们。
