Exalto Lieza G, van der Flier Wiesje M, van Boheemen Caroline J M, Kappelle L Jaap, Vrenken Hugo, Teunissen Charlotte, Koene Ted, Scheltens Phillip, Biessels Geert Jan
Department of Neurology, Brain Centre Rudolf Magnus Institute, University Medical Centre Utrecht, Utrecht, The Netherlands; Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands.
Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands; Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands.
J Neurol Sci. 2015 Apr 15;351(1-2):18-23. doi: 10.1016/j.jns.2015.02.004. Epub 2015 Feb 9.
The metabolic syndrome (MetS) refers to a cluster of cardiovascular risk factors that is associated with an increased risk of cognitive impairment and dementia. It is unclear however, if the presence of the MetS is associated with a particular clinical profile or a different prognosis in patients with cognitive complaints or early dementia.
To compare 1) the clinical profile and 2) the prognosis of patients attending a memory clinic according to the presence or absence of MetS.
Longitudinal cohort.
Memory clinic.
We included and followed 86 consecutive patients (average age of 66.7 (SD 9.7)) from the Amsterdam Dementia Cohort with an MMSE>22.
Clinical profile (neuropsychological examination, brain MRI, cerebrospinal fluid (CSF) biomarkers, clinical diagnosis) on an initial standardized diagnostic assessment was compared according to MetS status. Progression to dementia was assessed in initially nondemented patients (subjective complaints n=40, mild cognitive impairment n=24, follow-up available in 59).
35 (41%) patients met the MetS criteria. Demographics were similar between patients with or without the MetS. At baseline, diagnosis, cognitive performance, severity of degenerative or vascular abnormalities on MRI, and CSF amyloid and tau levels did not differ between the groups (all p>0.05). Among nondemented patients, however, MetS was associated with worse performance on executive function, attention & speed and visuoconstructive ability (z-scores, p<0.05). During a mean follow-up of 3.4years a similar proportion of patients with (4; 17%) and without (6; 17%) the MetS progressed to dementia (p=0.45).
Among nondemented patients presenting at a memory clinic MetS was associated with slightly worse cognitive performance (worse on tasks assessing executive functions, visuo-constructive ability, attention & speed), but conversion rate to dementia was not increased.
代谢综合征（MetS）指的是一组心血管危险因素，与认知障碍和痴呆风险增加相关。然而，目前尚不清楚MetS的存在是否与认知功能障碍或早期痴呆患者的特定临床特征或不同预后相关。
比较1）根据是否存在MetS，记忆门诊患者的临床特征；2）其预后情况。
纵向队列研究。
记忆门诊。
我们纳入并随访了阿姆斯特丹痴呆队列中连续的86例患者（平均年龄66.7岁（标准差9.7）），其简易精神状态检查表（MMSE）评分>22。
根据MetS状态，比较初始标准化诊断评估时的临床特征（神经心理学检查、脑磁共振成像（MRI）、脑脊液（CSF）生物标志物、临床诊断）。对最初未患痴呆的患者（主观认知障碍n = 40，轻度认知障碍n = 24，59例有随访数据）进行痴呆进展评估。
35例（41%）患者符合MetS标准。有或无MetS的患者人口统计学特征相似。基线时，两组在诊断、认知表现、MRI上退行性或血管异常的严重程度以及CSF淀粉样蛋白和tau水平方面均无差异（所有p>0.05）。然而，在未患痴呆的患者中，MetS与执行功能、注意力和速度以及视觉构建能力方面的较差表现相关（z分数，p<0.05）。在平均3.4年的随访期间，患有MetS（4例；17%）和未患MetS（6例；17%）的患者进展为痴呆的比例相似（p = 0.45）。
在记忆门诊就诊的未患痴呆的患者中，MetS与稍差的认知表现相关（在评估执行功能、视觉构建能力、注意力和速度的任务中表现更差），但痴呆转化率并未增加。
