Buratti Laura, Balestrini Simona, Altamura Claudia, Viticchi Giovanna, Falsetti Lorenzo, Luzzi Simona, Provinciali Leandro, Vernieri Fabrizio, Silvestrini Mauro
Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
Neurology Unit, Campus Bio-Medico University, Rome, Italy.
J Alzheimers Dis. 2015;45(3):883-90. doi: 10.3233/JAD-143135.
Defining reliable markers of conversion to dementia could be the first step in order to identify appropriate treatment strategies for mild cognitive impairment (MCI) patients.
To develop a tool able to predict the risk of progression from MCI to Alzheimer's disease (AD).
406 MCI patients were included and followed for a one-year period. Demographic characteristics, vascular risk factors, extent of cerebrovascular lesions, markers of carotid atherosclerosis investigated with an ultrasonographic assessment (plaque index and intima-media thickness) and cerebrovascular reactivity to apnea (breath-holding index) were considered as potential predictors of conversion.
106 (26%) MCI patients showed a conversion to AD. Plaque index, intima-media thickness, and breath-holding index were relevant predictors of conversion (p = 0.042; p = 0.003; p < 0.001, multivariate logistic regression analysis). A simplified scoring system was devised based on the magnitude of the estimated multinomial logistic regression β coefficient results. A total score was calculated as the sum of each predictive factor which resulted in a 0-5 range. The optimal cut-off score was ≥3 (sensitivity, 23.6%, 95% CI 15.9%-32.8%; specificity, 97.7%, 95% CI 95.3%-99.1%; positive likelihood ratio, 10.1, 95% CI 4.5%-22.7%; negative likelihood ratio, 0.78, 95% CI 0.70%-0.87%). The AUC was 0.71 (95% CI, 0.65-0.77).
Our findings show the possibility to obtain a predictive indicator of the risk of conversion from MCI to dementia by considering the presence of both atherosclerotic changes in the carotid district and impairment of cerebral hemodynamics. Such an approach may allow us to formulate a correct prognosis in more than 70% of patients with amnesic MCI.
确定可靠的痴呆转化标志物可能是为轻度认知障碍（MCI）患者确定合适治疗策略的第一步。
开发一种能够预测MCI进展为阿尔茨海默病（AD）风险的工具。
纳入406例MCI患者并随访1年。人口统计学特征、血管危险因素、脑血管病变程度、通过超声评估研究的颈动脉粥样硬化标志物（斑块指数和内膜中层厚度）以及对呼吸暂停的脑血管反应性（屏气指数）被视为转化的潜在预测因素。
106例（26%）MCI患者转化为AD。斑块指数、内膜中层厚度和屏气指数是转化的相关预测因素（p = 0.042；p = 0.003；p < 0.001，多因素逻辑回归分析）。基于估计的多项逻辑回归β系数结果的大小设计了一个简化评分系统。计算总分作为每个预测因素的总和，范围为0至5。最佳截断分数为≥3（敏感性，23.6%，95%CI 15.9%-32.8%；特异性，97.7%，95%CI 95.3%-99.1%；阳性似然比，10.1，95%CI 4.5%-22.7%；阴性似然比，0.78，95%CI 0.70%-0.87%）。曲线下面积为0.71（95%CI，0.65-0.77）。
我们的研究结果表明，通过考虑颈动脉区的动脉粥样硬化变化和脑血流动力学损害，有可能获得MCI转化为痴呆风险的预测指标。这种方法可能使我们能够为超过70%的遗忘型MCI患者制定正确的预后。
