From the Alzheimer Center Limburg (S.K., R.H., P.-J.V., P.A., F.R.J.V., I.R.), School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht; and Alzheimer Center & Department of Neurology (N.S., Y.A.L.P., W.M.v.d.F., P.S., P.-J.V.), Department of Medical Psychology (T.K.), Neuroscience Campus Amsterdam, and Department Epidemiology & Biostatistics (W.M.v.d.F.), VU University Medical Center, Amsterdam, the Netherlands.
Neurology. 2013 Oct 8;81(15):1342-9. doi: 10.1212/WNL.0b013e3182a82536. Epub 2013 Aug 30.
To identify the existence of discrete cognitive subtypes among memory clinic patients without dementia and test their prognostic values.
In a retrospective cohort study of 635 patients without dementia visiting the Alzheimer centers in Maastricht or Amsterdam, latent profile analysis identified cognitive subtypes based on immediate and delayed memory recall, delayed recognition, information-processing speed, attention, verbal fluency, and executive functions. Time to dementia was tested in weighted Cox proportional hazard models adjusted for confounders.
Five latent classes represented participants with high-normal cognition (15%), low-normal cognition (37%), primary memory impairment in recall (MI) (36%), memory impairment in recall and recognition (MI+) (5%), and primary nonmemory impairment (NMI) (6%). Compared with low-normal cognition, participants with NMI had the highest risk of dementia (hazard ratio [HR] = 5.94, 95% confidence interval [CI] = 3.46-10.18) followed by MI (HR = 3.05, 95% CI = 2.09-4.46) and MI+ (HR = 3.26, 95% CI = 1.72-6.17), while participants with high-normal cognition had the lowest risk (HR = 0.24, 95% CI = 0.07-0.80). Subtypes further showed differential relationships with dementia types, with MI and MI+ most often converting to Alzheimer-type dementia and NMI to other forms of dementia.
Cognitive subtypes can be empirically identified in otherwise heterogeneous samples of memory clinic patients and largely confirm current strategies to distinguish between amnestic and nonamnestic impairment. Studying more homogeneous cognitive subtypes may improve understanding of disease mechanisms and outcomes.
在无痴呆的记忆门诊患者中确定离散认知亚型的存在，并检验其预后价值。
在一项对 635 名无痴呆症、在马斯特里赫特或阿姆斯特丹阿尔茨海默病中心就诊的患者的回顾性队列研究中，基于即时和延迟记忆回忆、延迟识别、信息处理速度、注意力、词语流畅性和执行功能，使用潜在剖面分析确定认知亚型。使用加权 Cox 比例风险模型对混杂因素进行调整后，检验痴呆时间。
五种潜在类别代表了具有高正常认知（15%）、低正常认知（37%）、回忆性原发性记忆障碍（MI）（36%）、回忆和识别性记忆障碍（MI+）（5%）和原发性非记忆障碍（NMI）（6%）的参与者。与低正常认知相比，NMI 患者痴呆的风险最高（风险比[HR] = 5.94，95%置信区间[CI] = 3.46-10.18），其次是 MI（HR = 3.05，95% CI = 2.09-4.46）和 MI+（HR = 3.26，95% CI = 1.72-6.17），而高正常认知患者的风险最低（HR = 0.24，95% CI = 0.07-0.80）。亚型进一步显示与痴呆类型的不同关系，MI 和 MI+最常转化为阿尔茨海默病型痴呆，NMI 转化为其他形式的痴呆。
可以在无痴呆的记忆门诊患者的异质样本中经验性地确定认知亚型，并且在很大程度上证实了当前区分遗忘型和非遗忘型损伤的策略。研究更同质的认知亚型可能会提高对疾病机制和结果的理解。
