Center for Epidemiologic Studies, Department of Psychology, Utah State University, Logan, USA.
Am J Geriatr Psychiatry. 2011 Jun;19(6):532-42. doi: 10.1097/JGP.0b013e3181faec23.
Progression of Alzheimer dementia (AD) is highly variable. Most estimates derive from convenience samples from dementia clinics or research centers where there is substantial potential for survival bias and other distortions. In a population-based sample of incident AD cases, we examined progression of impairment in cognition, function, and neuropsychiatric symptoms, and the influence of selected variables on these domains.
Longitudinal, prospective cohort study.
Cache County (Utah).
Three hundred twenty-eight persons with a diagnosis of possible/probable AD.
Mini-Mental State Exam (MMSE), Clinical Dementia Rating sum-of-boxes (CDR-sb), and Neuropsychiatric Inventory (NPI).
Over a mean follow-up of 3.80 (range: 0.07-12.90) years, the mean (SD) annual rates of change were -1.53 (2.69) scale points on the MMSE, 1.44 (1.82) on the CDR-sb, and 2.55 (5.37) on the NPI. Among surviving participants, 30% to 58% progressed less than 1 point per year on these measures, even 5 to 7 years after dementia onset. Rates of change were correlated between MMSE and CDR-sb (r = -0.62, df = 201, p < 0.001) and between the CDR-sb and NPI (r = 0.20, df = 206, p < 0.004). Female subjects (LR χ = 8.7, df = 2, p = 0.013) and those with younger onset (likelihood ratio [LR] χ = 5.7, df = 2, p = 0.058) declined faster on the MMSE. Although one or more apolipoprotein E ε 4 alleles and ever use of FDA-approved antidementia medications were associated with initial MMSE scores, neither was related to the rate of progression in any domain.
A significant proportion of persons with AD progresses slowly. The results underscore differences between population-based versus clinic-based samples and suggest ongoing need to identify factors that may slow the progression of AD.
阿尔茨海默病（AD）的进展高度可变。大多数估计来自痴呆症诊所或研究中心的便利样本，这些样本中存在大量生存偏差和其他扭曲的可能性。在一项基于人群的 AD 病例中，我们研究了认知、功能和神经精神症状损伤的进展情况，以及选定变量对这些领域的影响。
纵向、前瞻性队列研究。
Cache 县（犹他州）。
328 名患有可能/可能的 AD 诊断的人。
迷你精神状态检查（MMSE）、临床痴呆评定量表总和框（CDR-sb）和神经精神疾病问卷（NPI）。
在平均 3.80 年（范围：0.07-12.90）的随访中，MMSE 的平均（SD）年变化率为-1.53（2.69）个刻度，CDR-sb 为 1.44（1.82），NPI 为 2.55（5.37）。在幸存的参与者中，即使在痴呆症发病后 5 到 7 年，仍有 30%至 58%的人每年的这些指标进展不到 1 分。MMSE 和 CDR-sb 之间的变化率呈正相关（r=-0.62，df=201，p<0.001），CDR-sb 和 NPI 之间的变化率呈正相关（r=0.20，df=206，p<0.004）。女性受试者（LR χ=8.7，df=2，p=0.013）和发病年龄较小的受试者（似然比[LR] χ=5.7，df=2，p=0.058）在 MMSE 上下降更快。尽管一个或多个载脂蛋白 E ε 4 等位基因和曾使用美国食品和药物管理局批准的抗痴呆药物与初始 MMSE 评分相关，但在任何领域的进展率方面均无相关性。
相当一部分 AD 患者进展缓慢。研究结果强调了基于人群的样本与基于诊所的样本之间的差异，并表明需要继续确定可能减缓 AD 进展的因素。
