回顾性鉴定和特征分析前瞻性人群队列中的轻度认知障碍。
Retrospective identification and characterization of mild cognitive impairment from a prospective population cohort.
机构信息
Inserm U, Université de Montpellier, France.
出版信息
Am J Geriatr Psychiatry. 2010 Aug;18(8):692-700. doi: 10.1097/jgp.0b013e3181df4897.
OBJECTIVES
Mild cognitive impairment (MCI) case-finding criteria have low specificity in general population studies. This study retrospectively identifies cases of MCI and determines baseline criteria giving the highest discriminability. The ability of these criteria to increase current case detection specificity is estimated.
DESIGN
A population-based cohort was recruited from electoral rolls from three French cities. Clinical and environmental characteristics were evaluated at baseline and at 2- and 4-year follow-up. The clinical characteristics of incident cases of dementia were examined retrospectively.
PARTICIPANTS
Eight thousand nine hundred nineteen persons aged 65 years and older without dementia (60.8% women) were included in this study. The mean age (SD) of the participants was 74.2 (5.6) years for men and 74.4 (5.6) years for women.
RESULTS
Three hundred twenty persons (3.6%) were retrospectively classified as MCI at baseline. This MCI group had poorer performance on all cognitive tests compared with the rest of the cohort, and a subsample undergoing MRI were found to have more white matter hyperintensities. The group were also characterized by the presence of an ApoE ε4 genotype (odds ratio [OR]: 2.17, confidence interval [CI]: 1.44-3.29 for men; OR: 2.27, CI: 1.59-3.24 for women) and instrumental activities of daily living loss (OR: 1.72, CI: 1.01-3.0 for men; OR: 1.49; CI: 0.97-2.3 for women). Women with MCI also had high depressive symptomatology (OR: 1.96; CI: 1.34-2.87), anticholinergic drug use (OR: 1.59; CI: 1.05-2.28), and low body mass index (OR: 1.54, CI: 1.05-2.28) and for men a history of stroke (OR: 2.17, CI: 1.16-4.05) and glycemia (OR: 1.72, CI: 1.13-2.71). Addition of these characteristics to conventional MCI definitions increases their specificity.
CONCLUSIONS
This general population study using a retrospective method for classifying persons with MCI identified gender-specific noncognitive clinical variables that may increase specificity.
目的
轻度认知障碍(MCI)的病例发现标准在一般人群研究中的特异性较低。本研究回顾性地确定了 MCI 病例,并确定了具有最高鉴别力的基线标准。估计这些标准提高当前病例检测特异性的能力。
设计
从法国三个城市的选民名单中招募了一个基于人群的队列。在基线和 2 年及 4 年随访时评估临床和环境特征。回顾性检查了痴呆症发病病例的临床特征。
参与者
本研究纳入了 8919 名无痴呆症(60.8%为女性)的 65 岁及以上人群。参与者的平均年龄(标准差)为男性 74.2(5.6)岁,女性 74.4(5.6)岁。
结果
320 人(3.6%)在基线时被回顾性分类为 MCI。与队列中的其余人群相比,该 MCI 组在所有认知测试中的表现均较差,并且进行 MRI 的亚样本显示出更多的脑白质高信号。该组的特征还包括载脂蛋白 E ε4 基因型(男性:优势比[OR]:2.17,置信区间[CI]:1.44-3.29;女性:OR:2.27,CI:1.59-3.24)和工具性日常生活活动丧失(男性:OR:1.72,CI:1.01-3.0;女性:OR:1.49;CI:0.97-2.3)。患有 MCI 的女性还具有较高的抑郁症状(OR:1.96;CI:1.34-2.87)、抗胆碱能药物使用(OR:1.59;CI:1.05-2.28)和较低的体质指数(OR:1.54,CI:1.05-2.28),而男性则有中风史(OR:2.17,CI:1.16-4.05)和血糖(OR:1.72,CI:1.13-2.71)。将这些特征添加到常规 MCI 定义中可提高其特异性。
结论
本研究使用回顾性方法对 MCI 患者进行分类,发现了可能提高特异性的性别特异性非认知临床变量。