Tabert Matthias H, Manly Jennifer J, Liu Xinhua, Pelton Gregory H, Rosenblum Sara, Jacobs Marni, Zamora Diana, Goodkind Madeleine, Bell Karen, Stern Yaakov, Devanand D P
Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, 1051 Riverside Dr, Unit 126, New York, NY 10032, USA.
Arch Gen Psychiatry. 2006 Aug;63(8):916-24. doi: 10.1001/archpsyc.63.8.916.
The likelihood of conversion to Alzheimer disease (AD) in mild cognitive impairment (MCI) and the "optimal" early markers of conversion need to be established.
To evaluate conversion rates to AD in subtypes of MCI and to identify neuropsychological measures most predictive of the time to conversion.
Patients were followed up semiannually and controls annually. Subtypes of MCI were determined by using demographically adjusted regression norms on neuropsychological tests. Survival analysis was used to identify the most predictive neuropsychological measures.
Memory disorders clinic.
One hundred forty-eight patients reporting memory problems and 63 group-matched controls.
A consensus diagnosis of probable AD.
At baseline, 108 patients met criteria for amnestic MCI: 87 had memory plus other cognitive domain deficits and 21 had pure memory deficits. The mean duration of follow-up for the 148 patients was 46.6 +/- 24.6 months. In 3 years, 32 (50.0%) of 64 amnestic-"plus" and 2 (10.0%) of 20 "pure" amnestic patients converted to AD (P = .001). In 148 patients, of 5 a priori predictors, the percent savings from immediate to delayed recall on the Selective Reminding Test and the Wechsler Adult Intelligence Scale-Revised Digit Symbol Test were the strongest predictors of time to conversion. From the entire neuropsychological test battery, a stepwise selection procedure retained 2 measures in the final model: total immediate recall on the Selective Reminding Test (odds ratio per 1-point decrease, 1.10; 95% confidence interval, 1.05-1.14; P < .0001) and Digit Symbol Test coding (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P = .01). The combined predictive accuracy of these 2 measures for conversion by 3 years was 86%.
Mild cognitively impaired patients with memory plus other cognitive domain deficits, rather than those with pure amnestic MCI, constituted the high-risk group. Deficits in verbal memory and psychomotor speed/executive function abilities strongly predicted conversion to AD.
轻度认知障碍（MCI）转化为阿尔茨海默病（AD）的可能性以及转化的“最佳”早期标志物有待确定。
评估MCI各亚型向AD的转化率，并确定最能预测转化时间的神经心理学指标。
对患者每半年随访一次，对对照组每年随访一次。MCI的亚型通过对神经心理学测试使用人口统计学调整回归标准来确定。采用生存分析来确定最具预测性的神经心理学指标。
记忆障碍诊所。
148名报告有记忆问题的患者和63名年龄匹配的对照组。
可能AD的共识诊断。
在基线时，108名患者符合遗忘型MCI标准：87名患者存在记忆及其他认知领域缺陷，21名患者存在单纯记忆缺陷。148名患者的平均随访时间为46.6±24.6个月。3年内，64名遗忘型“合并其他认知缺陷”患者中有32名（50.0%）、20名“单纯”遗忘型患者中有2名（10.0%）转化为AD（P = 0.001）。在148名患者中，5个先验预测指标中，选择性提醒测试中即时回忆与延迟回忆的节省百分比以及韦氏成人智力量表修订版数字符号测试是转化时间的最强预测指标。在整个神经心理学测试组中，逐步选择程序在最终模型中保留了2个指标：选择性提醒测试中的即时回忆总量（每降低1分的优势比为1.10；95%置信区间为1.05 - 1.14；P < 0.0001）和数字符号测试编码（优势比为1.06；95%置信区间为1.01 - 1.11；P = 0.01）。这2个指标对3年内转化的联合预测准确率为86%。
存在记忆及其他认知领域缺陷的轻度认知障碍患者，而非单纯遗忘型MCI患者，构成高危组。言语记忆和心理运动速度/执行功能能力缺陷强烈预测向AD的转化。
