认知障碍前期恢复正常的患者向痴呆进展的风险更高。
Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal.
机构信息
From the Divisions of Epidemiology (R.O.R., M.M.M., Y.E.G., W.A.R., R.C.P) and Biomedical Statistics and Informatics (R.H.C. V.S.P., T.J.H.C.), Department of Health Sciences Research; Department of Neurology (R.O.R., D.S.K., B.F.B., R.C.P.); Department of Psychiatry and Psychology (R.J.I.); and Division of Primary Care Internal Medicine, Department of Internal Medicine (E.G.T), Mayo Clinic, Rochester, MN; and Departments of Psychiatry & Psychology and Neurology (Y.E.G.), Mayo Clinic, Scottsdale, AZ.
出版信息
Neurology. 2014 Jan 28;82(4):317-25. doi: 10.1212/WNL.0000000000000055. Epub 2013 Dec 18.
OBJECTIVE
To estimate rates of progression from mild cognitive impairment (MCI) to dementia and of reversion from MCI to being cognitively normal (CN) in a population-based cohort.
METHODS
Participants (n = 534, aged 70 years and older) enrolled in the prospective Mayo Clinic Study of Aging were evaluated at baseline and every 15 months to identify incident MCI or dementia.
RESULTS
Over a median follow-up of 5.1 years, 153 of 534 participants (28.7%) with prevalent or incident MCI progressed to dementia (71.3 per 1,000 person-years). The cumulative incidence of dementia was 5.4% at 1 year, 16.1% at 2, 23.4% at 3, 31.1% at 4, and 42.5% at 5 years. The risk of dementia was elevated in MCI cases (hazard ratio [HR] 23.2, p < 0.001) compared with CN subjects. Thirty-eight percent (n = 201) of MCI participants reverted to CN (175.0/1,000 person-years), but 65% subsequently developed MCI or dementia; the HR was 6.6 (p < 0.001) compared with CN subjects. The risk of reversion was reduced in subjects with an APOE ε4 allele (HR 0.53, p < 0.001), higher Clinical Dementia Rating Scale-Sum of Boxes (HR 0.56, p < 0.001), and poorer cognitive function (HR 0.56, p < 0.001). The risk was also reduced in subjects with amnestic MCI (HR 0.70, p = 0.02) and multidomain MCI (HR 0.61, p = 0.003).
CONCLUSIONS
MCI cases, including those who revert to CN, have a high risk of progressing to dementia. This suggests that diagnosis of MCI at any time has prognostic value.
目的
在基于人群的队列中，估计从轻度认知障碍（MCI）到痴呆的进展率，以及从 MCI 恢复到认知正常（CN）的逆转率。
方法
参加前瞻性梅奥诊所衰老研究的 534 名参与者（年龄在 70 岁及以上）在基线和每 15 个月进行评估，以确定是否发生新发 MCI 或痴呆。
结果
在中位数为 5.1 年的随访期间，534 名患有或发生过 MCI 的参与者中有 153 名（28.7%）进展为痴呆（71.3/1000 人年）。痴呆的累积发病率为 1 年时为 5.4%，2 年时为 16.1%，3 年时为 23.4%，4 年时为 31.1%，5 年时为 42.5%。与 CN 受试者相比，MCI 病例的痴呆风险增加（风险比[HR]23.2，p<0.001）。38%（n=201）的 MCI 参与者恢复为 CN（175.0/1000 人年），但 65%随后发生 MCI 或痴呆；与 CN 受试者相比，HR 为 6.6（p<0.001）。APOE ε4 等位基因（HR 0.53，p<0.001）、较高的临床痴呆评定量表-总和分（HR 0.56，p<0.001）和较差的认知功能（HR 0.56，p<0.001）的受试者，其恢复风险降低。遗忘型 MCI（HR 0.70，p=0.02）和多域 MCI（HR 0.61，p=0.003）的受试者风险也降低。
结论
MCI 病例，包括那些恢复为 CN 的病例，进展为痴呆的风险很高。这表明在任何时候诊断 MCI 都具有预后价值。
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