Wien Center for Alzheimer's Disease and Memory Disorders, Miami Beach, Florida, USA.
Am J Geriatr Psychiatry. 2011 Nov;19(11):951-60. doi: 10.1097/JGP.0b013e3182107c69.
To compare clinical, imaging, and neuropsychological characteristics and longitudinal course of subjects with pre-mild cognitive impairment (pre-MCI), who exhibit features of MCI on clinical examination but lack impairment on neuropsychological examination, to subjects with no cognitive impairment (NCI), nonamnestic MCI (naMCI), amnestic MCI (aMCI), and mild dementia.
For 369 subjects, clinical dementia rating sum of boxes (CDR-SB), ApoE genotyping, cardiovascular risk factors, parkinsonism (UPDRS) scores, structural brain MRIs, and neuropsychological testing were obtained at baseline, whereas 275 of these subjects received an annual follow-up for 2-3 years.
At baseline, pre-MCI subjects showed impairment on tests of executive function and language, higher apathy scores, and lower left hippocampal volumes (HPCV) in comparison to NCI subjects. Pre-MCI subjects showed less impairment on at least one memory measure, CDR-SB and UPDRS scores, in comparison to naMCI, aMCI and mild dementia subjects. Follow-up over 2-3 years showed 28.6% of pre-MCI subjects, but less than 5% of NCI subjects progressed to MCI or dementia. Progression rates to dementia were equivalent between naMCI (22.2%) and aMCI (34.5%) groups, but greater than for the pre-MCI group (2.4%). Progression to dementia was best predicted by the CDR-SB, a list learning and executive function test.
This study demonstrates that clinically defined pre-MCI has cognitive, functional, motor, behavioral and imaging features that are intermediate between NCI and MCI states at baseline. Pre-MCI subjects showed accelerated rates of progression to MCI as compared to NCI subjects, but slower rates of progression to dementia than MCI subjects.
比较临床、影像学和神经心理学特征以及纵向病程，以评估表现出临床检查中轻度认知障碍（MCI）特征但神经心理学检查中无认知障碍的患者（预 MCI 患者）与无认知障碍（NCI）、非遗忘型轻度认知障碍（naMCI）、遗忘型轻度认知障碍（aMCI）和轻度痴呆患者的异同。
对 369 名受试者进行临床痴呆评定总和量表（CDR-SB）、载脂蛋白 E 基因分型、心血管危险因素、帕金森病（UPDRS）评分、结构脑 MRI 和神经心理学测试，所有受试者在基线时均进行上述检查，其中 275 名受试者在 2-3 年内接受了每年一次的随访。
在基线时，与 NCI 受试者相比，预 MCI 受试者在执行功能和语言测试中表现出认知障碍，冷漠评分更高，左海马体积（HPCV）更低。与 naMCI、aMCI 和轻度痴呆受试者相比，预 MCI 受试者在至少一项记忆测试、CDR-SB 和 UPDRS 评分上的认知障碍程度较轻。在 2-3 年的随访中，28.6%的预 MCI 受试者发展为 MCI 或痴呆，而 NCI 受试者中这一比例不到 5%。naMCI（22.2%）和 aMCI（34.5%）组的痴呆进展率相当，但高于预 MCI 组（2.4%）。CDR-SB、列表学习和执行功能测试是预测痴呆进展的最佳指标。
本研究表明，临床定义的预 MCI 在基线时具有介于 NCI 和 MCI 状态之间的认知、功能、运动、行为和影像学特征。与 NCI 受试者相比，预 MCI 受试者向 MCI 发展的速度更快，但向痴呆发展的速度比 MCI 受试者慢。
