Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Curr Opin Psychiatry. 2011 May;24(3):237-42. doi: 10.1097/YCO.0b013e328344696b.
To review evidence on the validity and utility of recent approaches to subtyping late-life mild cognitive impairment.
There is growing evidence that amnestic mild cognitive impairment is associated with biomarkers for Alzheimer's disease, while nonamnestic mild cognitive impairment maps more closely to cerebrovascular disease. The former is more likely to progress to dementia than the latter. Mild impairment in multiple cognitive domains appears to represent a more advanced disease state than single-domain impairment, and is more likely to progress to dementia. The cognitive subtypes have imprecise boundaries and have limited ecological validity. Approaches to subtyping that also incorporate biomarkers increase diagnostic specificity and have greater predictive value. However, these approaches have yet to be validated outside specialized memory clinic populations.
Mild cognitive impairment as currently defined is still etiologically and prognostically heterogeneous, particularly outside specialty clinical settings. The objective of further subtyping is to delineate subgroups that are more clinically homogeneous. The current cognitive subtypes have some validity and utility but additional approaches should be explored so as to enhance these properties.
回顾近期老年轻度认知障碍亚型划分方法的有效性和实用性的证据。
越来越多的证据表明，遗忘型轻度认知障碍与阿尔茨海默病的生物标志物有关，而非遗忘型轻度认知障碍与脑血管疾病更为相关。前者比后者更有可能发展为痴呆。多个认知领域的轻度损害似乎比单一领域的损害代表着更严重的疾病状态，更有可能发展为痴呆。认知亚型的划分边界不精确，且具有有限的生态有效性。将生物标志物纳入其中的亚型划分方法可提高诊断的特异性和预测价值。然而，这些方法尚未在专门的记忆诊所人群之外得到验证。
目前定义的轻度认知障碍在病因学和预后上仍然存在异质性，尤其是在专业临床环境之外。进一步进行亚型划分的目的是划定更具有临床同质性的亚组。目前的认知亚型具有一定的有效性和实用性，但应该探索其他方法以增强这些特性。
