Fondazione Santa Lucia IRCCS, Rome, Italy.
Dement Geriatr Cogn Disord. 2010;30(3):219-28. doi: 10.1159/000319533. Epub 2010 Sep 14.
Alzheimer disease (AD) has heterogeneous clinical manifestations. Different neuropsychological profiles in AD patients might be indicative of the diffusion of the pathological process and might be associated with differences in rates of disease progression.
We studied 154 newly diagnosed AD patients (65.6% women; mean age: 73 years). Performance in memory, executive functions, praxis and language domains was categorized into mild, moderate and severe impairment. The time-dependent probability of losing 5 points on the Mini-Mental State Examination (MMSE) over 2 years was considered as disease progression and evaluated by survival analysis.
One fourth of the patients decreased by ≥ 5 MMSE points over the 2-year follow-up. Rapid disease progression was more frequent in more educated patients and in those with moderate severity of global cognitive impairment. In univariate analysis, more severe memory and executive functioning impairment were associated with higher probabilities of progression. The association with memory was explained by differences in executive function impairment that remained statistically significant in multivariate analyses.
Patients with more severe executive functioning impairment have a worse prognosis over 2 years. This might be due to involvement of the prefrontal cortex by the pathological process of AD in patients with severe executive deficits.
阿尔茨海默病（AD）具有异质性的临床表现。AD 患者不同的神经心理学特征可能表明病理过程的扩散，并可能与疾病进展速度的差异有关。
我们研究了 154 名新诊断的 AD 患者（65.6%为女性；平均年龄：73 岁）。将记忆、执行功能、实践和语言领域的表现分为轻度、中度和重度损伤。将 2 年内 Mini-Mental State Examination（MMSE）减少 5 分的时间依赖性概率视为疾病进展，并通过生存分析进行评估。
四分之一的患者在 2 年的随访中 MMSE 评分下降≥5 分。受教育程度较高的患者和认知障碍程度中度的患者更易出现快速疾病进展。在单因素分析中，更严重的记忆和执行功能障碍与更高的进展概率相关。与记忆的关联可由执行功能障碍的差异解释，在多变量分析中仍具有统计学意义。
执行功能障碍更严重的患者在 2 年内的预后更差。这可能是由于 AD 病理过程累及前额叶皮层，导致执行功能严重受损的患者出现这种情况。
