Jessen Frank, Wiese Birgitt, Cvetanovska Gabriela, Fuchs Angela, Kaduszkiewicz Hanna, Kölsch Heike, Luck Tobias, Mösch Edelgard, Pentzek Michael, Riedel-Heller Steffi G, Werle Jochen, Weyerer Siegfried, Zimmermann Thomas, Maier Wolfgang, Bickel Horst
Department of Psychiatry, University of Bonn, Bonn, Germany.
Psychol Med. 2007 Dec;37(12):1753-62. doi: 10.1017/S0033291707001122. Epub 2007 Jul 11.
The association of subjective memory impairment (SMI) with cognitive performance in healthy elderly subjects is poor because of confounds such as depression. However, SMI is also a predictor for future dementia. Thus, there is a need to identify subtypes of SMI that are particularly related to inferior memory performance and may represent at-risk stages for cognitive decline.
A total of 2389 unimpaired subjects were recruited from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe), as part of the German Competence Network on Dementia. Clusters of SMI according to patterns of response to SMI questions were identified. Gender, age, depressive symptoms, apolipoprotein E (apoE) genotype, delayed recall and verbal fluency were included in a Classification and Regression Tree (CART) analysis to identify discriminators between the clusters.
We identified three clusters. Cluster 1 contained subjects without memory complaints. Cluster 2 contained subjects with general memory complaints, but mainly without memory complaints on individual tasks of daily living. Cluster 3 contained subjects with general memory complaints and complaints on individual tasks of daily living. Depressive symptoms, as the first-level discriminator, distinguished between clusters 1 and 2 versus cluster 3. In subjects with only a few depressive symptoms, delayed recall discriminated between cluster 1 versus clusters 2 and 3.
In SMI subjects with only a minor number of depressive symptoms, memory complaints are associated with delayed recall. As delayed recall is a sensitive predictor for future cognitive decline, SMI may be the first manifestation of future dementia in elderly subjects without depression.
在健康老年人群中，由于存在诸如抑郁等混杂因素，主观记忆障碍（SMI）与认知表现之间的关联并不紧密。然而，SMI也是未来痴呆症的一个预测指标。因此，有必要识别出与较差记忆表现特别相关且可能代表认知衰退风险阶段的SMI亚型。
作为德国痴呆症能力网络的一部分，从德国初级保健患者衰老、认知与痴呆研究（AgeCoDe）中招募了总共2389名未受损受试者。根据对SMI问题的回答模式确定了SMI集群。将性别、年龄、抑郁症状、载脂蛋白E（apoE）基因型、延迟回忆和语言流畅性纳入分类与回归树（CART）分析，以识别集群之间的区分因素。
我们识别出三个集群。集群1包含没有记忆主诉的受试者。集群2包含有一般记忆主诉但在日常生活个别任务上主要没有记忆主诉的受试者。集群3包含有一般记忆主诉且在日常生活个别任务上有记忆主诉的受试者。抑郁症状作为一级区分因素，区分了集群1和2与集群3。在只有少数抑郁症状的受试者中，延迟回忆区分了集群1与集群2和3。
在只有少数抑郁症状的SMI受试者中，记忆主诉与延迟回忆相关。由于延迟回忆是未来认知衰退的一个敏感预测指标，SMI可能是无抑郁的老年受试者未来痴呆症的首个表现。
