Wilson Robert S, Leurgans Sue E, Boyle Patricia A, Bennett David A
Rush Alzheimer's Disease Center, Department of Neurological Science, Rush University Medical Center, 600 S Paulina Ave, Ste 1038, Chicago, IL 60612, USA.
Arch Neurol. 2011 Mar;68(3):351-6. doi: 10.1001/archneurol.2011.31.
To characterize the course of cognitive decline during the prodromal phase of Alzheimer disease.
Longitudinal cohort study with up to 16 years of observation.
Older persons from 2 studies underwent annual clinical evaluations that included cognitive function testing and clinical classification of mild cognitive impairment, dementia, and Alzheimer disease. At baseline, there were 2071 individuals without dementia and 1511 without cognitive impairment.
During follow-up, 462 persons developed Alzheimer disease (20 with dementia solely due to another condition were excluded). Five to six years before diagnosis, the rate of global cognitive decline accelerated more than 15-fold. The acceleration in cognitive decline occurred slightly earlier for semantic memory (76 months before diagnosis) and working memory (75 months) than other cognitive functions. Mild cognitive impairment was also preceded by years of cognitive decline that began earlier (80 months before diagnosis) and proceeded more rapidly (annual loss of 0.102 unit) in the amnestic than in the nonamnestic (62 months, 0.072 unit) subtype.
Dementia due to Alzheimer disease is preceded by about 5 to 6 years of accelerated decline in multiple cognitive functions. By contrast, little decline is evident in persons who do not develop Alzheimer disease.
描述阿尔茨海默病前驱期认知衰退的进程。
长达16年观察期的纵向队列研究。
两项研究中的老年人接受了年度临床评估，包括认知功能测试以及轻度认知障碍、痴呆和阿尔茨海默病的临床分类。基线时，有2071名无痴呆个体和1511名无认知障碍个体。
随访期间，462人患上阿尔茨海默病（排除20名仅因其他疾病导致痴呆的患者）。在诊断前5至6年，整体认知衰退速率加快了15倍以上。语义记忆（诊断前76个月）和工作记忆（诊断前75个月）的认知衰退加速比其他认知功能略早。遗忘型轻度认知障碍之前也有多年的认知衰退，其开始时间更早（诊断前80个月），且衰退速度比非遗忘型（诊断前62个月）更快（每年损失0.102个单位，而非遗忘型为每年损失0.072个单位）。
阿尔茨海默病所致痴呆之前有大约5至6年多种认知功能的加速衰退。相比之下，未患阿尔茨海默病的人几乎没有明显衰退。
