Palmer K, Berger A K, Monastero R, Winblad B, Bäckman L, Fratiglioni L
Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
Neurology. 2007 May 8;68(19):1596-602. doi: 10.1212/01.wnl.0000260968.92345.3f.
To determine the occurrence of neuropsychiatric symptomatology and the relation to future development of Alzheimer disease (AD) in persons with and without mild cognitive impairment (MCI).
We followed 185 persons with no cognitive impairment and 47 with MCI (amnestic and multidomain), ages 75 to 95, from the population-based Kungsholmen Project, Stockholm, Sweden, for 3 years. Three types of neuropsychiatric symptoms were assessed at baseline: mood-related depressive symptoms, motivation-related depressive symptoms, and anxiety-related symptomatology. AD at 3-year follow-up was diagnosed according to Diagnostic and Statistical Manual for Mental Disorders-III-R criteria.
Psychiatric symptoms occurred more frequently in persons with MCI (36.2% mood, 36.2% motivation, and 46.8% anxiety symptoms) than in cognitively intact elderly individuals (18.4% mood, 13.0% motivation, and 24.9% anxiety). Of persons with both MCI and anxiety symptoms, 83.3% developed AD over follow-up vs 6.1% of cognitively intact persons and 40.9% persons who had MCI without anxiety. Among persons with MCI, the 3-year risk of progressing to AD almost doubled with each anxiety symptom (relative risk [RR] = 1.8 [1.2 to 2.7] per symptom). Conversely, among cognitively intact subjects, only symptoms of depressive mood were related to AD development (RR = 1.9 [1.0 to 3.6] per symptom).
The predictive validity of mild cognitive impairment (MCI) for identifying future Alzheimer disease (AD) cases is improved in the presence of anxiety symptoms. Mood-related depressive symptoms (dysphoria, suicidal ideation, etc.) in preclinical AD might be related to the neuropathologic mechanism, as they appear preclinically in persons both with and without MCI.
确定有无轻度认知障碍（MCI）者神经精神症状的发生率及其与阿尔茨海默病（AD）未来发展的关系。
我们对来自瑞典斯德哥尔摩基于人群的 Kungsholmen 项目中 185 名无认知障碍者和 47 名 MCI 者（遗忘型和多领域型）进行了为期 3 年的随访，这些研究对象年龄在 75 至 95 岁之间。在基线时评估了三种类型的神经精神症状：与情绪相关的抑郁症状、与动机相关的抑郁症状以及与焦虑相关的症状。3 年随访时的 AD 根据《精神障碍诊断与统计手册》第三版修订版标准进行诊断。
MCI 者中精神症状的发生率更高（情绪症状 36.2%、动机症状 36.2%以及焦虑症状 46.8%），高于认知功能正常的老年人（情绪症状 18.4%、动机症状 13.0%以及焦虑症状 24.9%）。在同时患有 MCI 和焦虑症状的人中，83.3%在随访期间发展为 AD，而认知功能正常者为 6.1%，患有 MCI 但无焦虑症状者为 40.9%。在 MCI 者中，每出现一种焦虑症状，进展为 AD 的 3 年风险几乎增加一倍（相对风险[RR]=1.8[1.2 至 2.7]每症状）。相反，在认知功能正常的受试者中，只有情绪抑郁症状与 AD 发展有关（RR = 1.9[1.0 至 3.6]每症状）。
存在焦虑症状时，轻度认知障碍（MCI）对识别未来阿尔茨海默病（AD）病例的预测效度得到提高。临床前期 AD 中与情绪相关的抑郁症状（烦躁不安、自杀观念等）可能与神经病理机制有关，因为它们在有和没有 MCI 的人中均在临床前期出现。
