Department of Neurology, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Neuroradiology Section, Fundación Jiménez Díaz, Madrid, Spain.
Am J Geriatr Psychiatry. 2012 Oct;20(10):827-35. doi: 10.1097/JGP.0b013e31823038c6.
: Finding variables that predict decline or stability in persons with amnestic mild cognitive impairment (aMCI) is an important step in identifying subjects in prodromal stages of dementia. This study tests a clinical observation suggesting that aMCI cases with better-preserved recognition skills, despite similar delayed recall deficits, are more likely to remain functionally stable.
: A cohort of 210 cases with aMCI, diagnosed with standardized criteria that had been followed up for 48 ± 12 months (range: 36-100), were divided into two groups according to their initial recognition memory discrimination index (DI) on the Hopkins Verbal Learning Test (DI ≥ or <8). We compared the two groups according to demographic and neuropsychological variables, cerebral small vessel disease, and outcome (progression to dementia versus stability as aMCI).
: Thirty-seven percent progressed to dementia. In the group with the higher DI scores (n = 107), only 21.5% of the cases converted, compared with 52.4% of lower scorers (n = 103; Fisher's test: p < 0.0001). Progression to dementia occurred significantly later in cases with higher DI (50 ± 17 versus 26 ± 11 months in cases with impaired DI, Mann-Whitney test, U statistic = 1092.5, p < 0.0001). The group with lower DI showed a threefold-increased rate of progression to dementia. A multivariate regression model revealed DI, delayed recall, age, and family history of dementia as the strongest predictors of dementia, in this order.
: The aMCI patients with better-preserved recognition at baseline have a more benign prognosis. Detection of these cases may aid in isolating other aMCI cases that are already in prodromal stages of AD and in selecting more homogeneous groups for clinical trials.
发现能够预测遗忘型轻度认知障碍（aMCI）患者衰退或稳定的变量，对于识别痴呆前阶段的受试者至关重要。本研究检验了一个临床观察结果，即尽管存在相似的延迟回忆缺陷，但识别技能保存较好的 aMCI 病例更有可能保持功能稳定。
一项队列研究纳入了 210 例符合标准化标准诊断的 aMCI 患者，随访时间为 48±12 个月（范围：36-100）。根据他们在 Hopkins 词语学习测试中的初始识别记忆辨别指数（DI），将这些患者分为两组（DI≥8 或<8）。我们比较了两组患者的人口统计学和神经心理学变量、脑小血管疾病以及结局（进展为痴呆与作为 aMCI 保持稳定）。
37%的患者进展为痴呆。在 DI 得分较高的组（n=107）中，仅有 21.5%的病例发生转换，而 DI 得分较低的组（n=103）中则有 52.4%的病例发生转换（Fisher 检验：p<0.0001）。DI 得分较高的病例进展为痴呆的时间明显晚于 DI 得分较低的病例（50±17 个月 vs. 26±11 个月，Mann-Whitney 检验，U 统计量=1092.5，p<0.0001）。DI 得分较低的组发生痴呆的风险增加了三倍。多元回归模型显示，DI、延迟回忆、年龄和痴呆家族史是预测痴呆的最强因素，按此顺序排列。
基线时识别能力保存较好的 aMCI 患者具有更好的预后。检测这些病例可能有助于隔离已经处于 AD 前驱阶段的其他 aMCI 病例，并为临床试验选择更同质的组。
