Am J Psychiatry. 2014 May;171(5):572-81. doi: 10.1176/appi.ajp.2014.13060821.
The authors conducted a prospective cohort study to estimate the risk of incident mild cognitive impairment in cognitively normal elderly (aged ≥70 years) individuals with or without neuropsychiatric symptoms at baseline. The research was conducted in the setting of the population-based Mayo Clinic Study of Aging.
A classification of normal cognitive aging, mild cognitive impairment, and dementia was adjudicated by an expert consensus panel based on published criteria. Hazard ratios and 95% confidence intervals were computed using Cox proportional hazards model, with age as a time scale. Baseline Neuropsychiatric Inventory Questionnaire data were available for 1,587 cognitively normal persons who underwent at least one follow-up visit.
The cohort was followed to incident mild cognitive impairment (N=365) or censoring variables (N=179) for a median of 5 years. Agitation (hazard ratio=3.06, 95% CI=1.89-4.93), apathy (hazard ratio=2.26, 95% CI=1.49-3.41), anxiety (hazard ratio=1.87, 95% CI=1.28-2.73), irritability (hazard ratio=1.84, 95% CI=1.31-2.58), and depression (hazard ratio=1.63, 95% CI=1.23-2.16), observed initially, increased risk for later mild cognitive impairment. Delusion and hallucination did not. A secondary analysis, limited in significance by the small number of study participants, showed that euphoria, disinhibition, and nighttime behaviors were significant predictors of nonamnestic mild cognitive impairment but not amnestic mild cognitive impairment. By contrast, depression predicted amnestic mild cognitive impairment (hazard ratio=1.74, 95% CI=1.22-2.47) but not nonamnestic mild cognitive impairment.
An increased incidence of mild cognitive impairment was observed in community-dwelling elderly adults who had nonpsychotic psychiatric symptoms at baseline. These baseline psychiatric symptoms were of similar or greater magnitude as biomarkers (genetic and structural MRI) in increasing the risk of incident mild cognitive impairment.
作者开展了一项前瞻性队列研究，旨在评估基线时有或无神经精神症状的认知正常老年人（年龄≥70 岁）发生轻度认知障碍的风险。该研究在基于人群的 Mayo 诊所老龄化研究中进行。
根据发表的标准，通过专家共识小组对正常认知老化、轻度认知障碍和痴呆的分类进行了裁决。使用 Cox 比例风险模型计算风险比和 95%置信区间，年龄为时间尺度。有 1587 名认知正常的人接受了至少一次随访，他们的基线神经精神疾病问卷数据可用。
该队列随访至发生轻度认知障碍（N=365）或截止变量（N=179），中位随访时间为 5 年。激越（风险比=3.06，95%CI=1.89-4.93）、淡漠（风险比=2.26，95%CI=1.49-3.41）、焦虑（风险比=1.87，95%CI=1.28-2.73）、易怒（风险比=1.84，95%CI=1.31-2.58）和抑郁（风险比=1.63，95%CI=1.23-2.16）最初观察到的症状增加了以后发生轻度认知障碍的风险。妄想和幻觉则没有。一项次要分析显示，在研究参与者数量较少的情况下，其意义有限，欣快、抑制障碍和夜间行为是非遗忘性轻度认知障碍的显著预测因素，但不是遗忘性轻度认知障碍的预测因素。相比之下，抑郁预测了遗忘性轻度认知障碍（风险比=1.74，95%CI=1.22-2.47），但不能预测非遗忘性轻度认知障碍。
在基线时有非精神病性精神症状的社区居住的老年成年人中，观察到轻度认知障碍的发病率增加。这些基线期精神症状在增加轻度认知障碍的风险方面与生物标志物（遗传和结构 MRI）具有相似或更大的作用。
