Busse A, Hensel A, Gühne U, Angermeyer M C, Riedel-Heller S G
Department of Psychiatry, University of Leipzig, Leipzig, Germany.
Neurology. 2006 Dec 26;67(12):2176-85. doi: 10.1212/01.wnl.0000249117.23318.e1.
To empirically validate the expanded concept of mild cognitive impairment (MCI), which differentiates between four clinical subtypes-amnestic MCI-single domain, amnestic MCI-multiple domains, nonamnestic MCI-single domain, and nonamnestic MCI-multiple domains-and to examine the prevalence, course, and outcome of these four clinical MCI subtypes.
We studied a community sample of 980 dementia-free individuals aged 75 years or older who participated in the Leipzig Longitudinal Study of the Aged (LEILA 75+). All participants were examined by neuropsychological testing based on 6 years of observation. The diagnoses of the four clinical MCI subtypes were made according to the original and to slightly modified criteria by Petersen et al. (2001) (both with a cutoff of 1.0 SD and with a cutoff of 1.5 SD). The complete range of outcome types (dementia, death, improvement, stable diagnosis, unstable diagnosis) was described for all subtypes. The relative predictive power of stable MCI for dementia onset was determined.
MCI-single domain is more frequent than MCI-multiple domains, and the nonamnestic MCI type is as frequent as the amnestic MCI type. The "MCI modified, 1.0 SD" criteria have the highest relative predictive power for the development of dementia (sensitivity = 74%, specificity = 73%). Alzheimer disease (AD) was the most common type of dementia at follow-up in all but one MCI subtype. Participants with nonamnestic MCI-multiple domains were more likely to progress to a non-AD dementia.
It has been assumed that each MCI subtype is associated with an increased risk for a particular type of dementia. We can only partially agree with this.
通过实证验证轻度认知障碍（MCI）的扩展概念，该概念区分了四种临床亚型——遗忘型MCI-单领域、遗忘型MCI-多领域、非遗忘型MCI-单领域和非遗忘型MCI-多领域，并研究这四种临床MCI亚型的患病率、病程和转归。
我们对980名75岁及以上无痴呆的个体进行了社区抽样研究，这些个体参与了莱比锡老年纵向研究（LEILA 75+）。所有参与者均接受了基于6年观察的神经心理学测试。根据Petersen等人（2001年）的原始标准和稍作修改的标准（均采用1.0标准差截断值和1.5标准差截断值）对四种临床MCI亚型进行诊断。描述了所有亚型的完整转归类型（痴呆、死亡、改善、诊断稳定、诊断不稳定）范围。确定了稳定型MCI对痴呆发病的相对预测能力。
MCI-单领域比MCI-多领域更常见，非遗忘型MCI类型与遗忘型MCI类型的频率相同。“MCI修改版, 1.0标准差”标准对痴呆发展的相对预测能力最高（敏感性 = 74%，特异性 = 73%）。除一种MCI亚型外，阿尔茨海默病（AD）是随访时最常见的痴呆类型。非遗忘型MCI-多领域的参与者更有可能进展为非AD痴呆。
人们一直认为每种MCI亚型与特定类型痴呆的风险增加相关。对此我们只能部分认同。
