Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
Neurology. 2010 Jan 19;74(3):210-7. doi: 10.1212/WNL.0b013e3181ca017d.
Cognitive fluctuations are spontaneous alterations in cognition, attention, and arousal. Fluctuations are a core feature of dementia with Lewy bodies, but the impact of fluctuations in healthy brain aging and Alzheimer disease (AD) are unknown.
Research participants (n = 511, age 78.1 +/- 8 years, education 14.9 +/- 3 years) enrolled in a longitudinal study of memory and aging at the Washington University Alzheimer Disease Research Center were assessed for the presence and severity of dementia with the Clinical Dementia Rating (CDR) and a neuropsychological test battery. Informant assessments of fluctuations with the Mayo Fluctuations Questionnaire and daytime level of alertness with the Mayo Sleep Questionnaire were completed.
After controlling for age and alertness level, participants with cognitive fluctuations (3 or 4 individual symptoms) were 4.6 times more likely to have dementia (95% confidence interval: 2.05, 10.40). Participants who presented with disorganized, illogical thinking were 7.8 times more likely to be rated CDR >0. The risk of being rated CDR 0.5 among those with fluctuations was 13.4 times higher than among those without fluctuations. The risk of being rated CDR 1 increased 34-fold among participants with fluctuations. Compared with participants without fluctuations, the presence of cognitive fluctuations corresponds to a decrease in performance across individual neuropsychological tests as well as composite scores.
Cognitive fluctuations occur in Alzheimer disease and, when present, significantly affect both clinical rating of dementia severity and neuropsychological performance. Assessment of fluctuations should be considered in the evaluation of patients for cognitive disorders.
认知波动是认知、注意力和觉醒的自发改变。波动是路易体痴呆的核心特征，但在健康大脑老化和阿尔茨海默病（AD）中波动的影响尚不清楚。
研究参与者（n = 511，年龄 78.1 +/- 8 岁，教育年限 14.9 +/- 3 年）参加了华盛顿大学阿尔茨海默病研究中心的一项记忆和衰老纵向研究，使用临床痴呆评定量表（CDR）和神经心理学测试量表评估痴呆的存在和严重程度。使用 Mayo 波动问卷评估波动的存在和严重程度，使用 Mayo 睡眠问卷评估白天警觉水平。
在控制年龄和警觉水平后，有认知波动（3 或 4 个个体症状）的参与者患痴呆的可能性增加 4.6 倍（95%置信区间：2.05，10.40）。出现思维紊乱、不合逻辑的参与者被评为 CDR >0 的可能性增加 7.8 倍。有波动的参与者被评为 CDR 0.5 的风险比无波动的参与者高 13.4 倍。有波动的参与者被评为 CDR 1 的风险增加了 34 倍。与无波动的参与者相比，认知波动的存在会导致个体神经心理学测试以及综合评分的表现下降。
认知波动发生在阿尔茨海默病中，并且存在波动会显著影响痴呆严重程度的临床评估和神经心理学表现。在评估认知障碍患者时，应考虑评估波动。
