From the Division of Psychiatry, University College London; and the Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore.
Am J Psychiatry. 2015 Apr;172(4):323-34. doi: 10.1176/appi.ajp.2014.14070878. Epub 2015 Feb 20.
Public health campaigns encouraging early help seeking have increased rates of mild cognitive impairment (MCI) diagnosis in Western countries, but we know little about how to treat or predict dementia outcomes in persons with the condition.
The authors searched electronic databases and references for longitudinal studies reporting potentially modifiable risk factors for incident dementia after MCI. Two authors independently evaluated study quality using a checklist. Meta-analyses were conducted of three or more studies.
There were 76 eligible articles. Diabetes and prediabetes increased risk of conversion from amnestic MCI to Alzheimer's dementia; risk in treated versus untreated diabetes was lower in one study. Diabetes was also associated with increased risk of conversion from any-type or nonamnestic MCI to all-cause dementia. Metabolic syndrome and prediabetes predicted all-cause dementia in people with amnestic and any-type MCI, respectively. Mediterranean diet decreased the risk of conversion to Alzheimer's dementia. The presence of neuropsychiatric symptoms or lower serum folate levels predicted conversion from any-type MCI to all-cause dementia, but less formal education did not. Depressive symptoms predicted conversion from any-type MCI to all-cause dementia in epidemiological but not clinical studies.
Diabetes increased the risk of conversion to dementia. Other prognostic factors that are potentially manageable are prediabetes and the metabolic syndrome, neuropsychiatric symptoms, and low dietary folate. Dietary interventions and interventions to reduce neuropsychiatric symptoms, including depression, that increase risk of conversion to dementia may decrease new incidence of dementia.
鼓励早期寻求帮助的公共卫生运动提高了西方国家轻度认知障碍（MCI）的诊断率，但我们对如何治疗或预测患有该疾病的人的痴呆症结果知之甚少。
作者搜索了电子数据库和参考文献，以寻找报告 MCI 后发生痴呆的潜在可改变风险因素的纵向研究。两位作者使用清单独立评估研究质量。对三项或更多研究进行了荟萃分析。
有 76 篇符合条件的文章。糖尿病和糖尿病前期增加了从遗忘型 MCI 向阿尔茨海默病痴呆转化的风险；一项研究中，治疗与未治疗的糖尿病相比，风险较低。糖尿病也与任何类型或非遗忘型 MCI 向所有原因痴呆的风险增加有关。代谢综合征和糖尿病前期分别预测了遗忘型和任何类型 MCI 患者的全因痴呆。地中海饮食降低了向阿尔茨海默病痴呆转化的风险。存在神经精神症状或血清叶酸水平较低预测了从任何类型 MCI 向全因痴呆的转化，但受教育程度较低则不会。抑郁症状预测了从任何类型 MCI 向全因痴呆的转化，但在流行病学研究中而不是在临床研究中。
糖尿病增加了向痴呆转化的风险。其他潜在可管理的预后因素是糖尿病前期和代谢综合征、神经精神症状以及低饮食叶酸。增加向痴呆转化风险的饮食干预和减少神经精神症状的干预措施，包括抑郁，可能会降低新的痴呆症发病率。
