Geroldi C, Rossi R, Calvagna C, Testa C, Bresciani L, Binetti G, Zanetti O, Frisoni G B
Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS San Giovanni di Dio FBF-The National Center for Research and Care of Alzheimer's Disease, via Pilastroni 4, 25125 Brescia, Italy.
J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1219-22. doi: 10.1136/jnnp.2005.082651. Epub 2006 Aug 4.
The diagnosis of mild cognitive impairment (MCI) is clinically unhelpful, as many patients with MCI develop dementia but many do not.
To identify clinical instruments easily applicable in the clinical routine that might be useful to predict progression to dementia in patients with MCI assessed in the outpatient facility of a memory clinic.
52 dementia-free patients (mean (standard deviation) age 70 (6) years; 56% women) with MCI, and 65 healthy controls (age 69 (6) years; 54% women) underwent brain magnetic resonance scan with standardised visual assessment of medial temporal atrophy (MTA) and subcortical cerebrovascular lesions (SVLs). Follow-up assessment occurred 15.4 (SD 3.4) months after baseline to detect incident dementia and improvement, defined as normal neuropsychological performance on follow-up.
Patients were classified into three groups according to the presence of memory disturbance only (MCI Mem), other neuropsychological deficits (MCI Oth) or both (MCI Mem+). MCI Mem and Mem+ showed MTA more frequently (31% and 47% v 5% and 14% of controls and MCI Oth, p<0.001). 11 patients developed dementia (annual rate 16.5%) and 7 improved on follow-up. The only independent predictor of progression was MTA (odds ratio (OR) 7.1, 95% confidence interval (CI) 1.4 to 35.0), whereas predictors of improvement were the absence of memory impairment (OR 18.5, 95% CI 2.0 to 171.3) and normal MRI scan (OR 10.0, 95% CI 1.7 to 60.2).
Neuropsychological patterns identify groups of patients with MCI showing specific clinical features and risk of progression to dementia. MTA clinically rated with a visual scale is the most relevant predictor of progression and improvement.
轻度认知障碍（MCI）的诊断在临床上并无帮助，因为许多MCI患者会发展为痴呆症，但也有许多患者不会。
确定在临床常规中易于应用的临床工具，这些工具可能有助于预测在记忆门诊的门诊设施中接受评估的MCI患者发展为痴呆症的情况。
52例无痴呆的MCI患者（平均（标准差）年龄70（6）岁；56%为女性）和65名健康对照者（年龄69（6）岁；54%为女性）接受了脑磁共振扫描，并对内侧颞叶萎缩（MTA）和皮质下脑血管病变（SVL）进行了标准化视觉评估。在基线后15.4（标准差3.4）个月进行随访评估，以检测新发痴呆症和改善情况，改善定义为随访时神经心理表现正常。
根据仅存在记忆障碍（MCI Mem）、其他神经心理缺陷（MCI Oth）或两者都有（MCI Mem+），将患者分为三组。MCI Mem和Mem+更频繁地出现MTA（分别为31%和47%，而对照组和MCI Oth分别为5%和14%，p<0.001）。11例患者发展为痴呆症（年发生率16.5%），7例在随访时有所改善。进展的唯一独立预测因素是MTA（优势比（OR）7.1，95%置信区间（CI）1.4至35.0），而改善的预测因素是无记忆障碍（OR 18.5，95%CI 2.0至171.3）和MRI扫描正常（OR 10.0，95%CI 1.7至60.2）。
神经心理模式可识别出具有特定临床特征和发展为痴呆症风险的MCI患者群体。用视觉量表进行临床评分的MTA是进展和改善的最相关预测因素。
