Pandya Seema Y, Lacritz Laura H, Weiner Myron F, Deschner Martin, Woon Fu L
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Dement Geriatr Cogn Disord. 2017;43(3-4):204-214. doi: 10.1159/000456070. Epub 2017 Mar 17.
BACKGROUND/AIMS: Few studies have examined predictors of reversion from mild cognitive impairment (MCI) to normal cognition. We sought to identify baseline predictors of reversion, using the National Alzheimer's Coordinating Center Uniform Data Set, by comparing MCI individuals who reverted to normal cognition to those who progressed to dementia.
Participants (n = 1,208) meeting MCI criteria were evaluated at the baseline visit and 3 subsequent annual visits. Clusters of baseline predictors of MCI reversion included demographic/genetic data, global functioning, neuropsychological functioning, medical health/dementia risk score, and neuropsychiatric symptoms. Stepwise logistic regression models identified predictors of MCI reversion per cluster, which were then entered into a final comprehensive model to find overall predictor(s).
At 2 years, 175 (14%) reverted to normal cognition, 612 (51%) remained MCI, and 421 (35%) progressed to dementia, with sustained diagnoses at 3 years. Significant variables associated with MCI reversion were younger age, being unmarried, absence of APOE ε4 allele, lower CDR-SOB score, and higher memory/language test scores.
A relatively sizable proportion of MCI individuals reverted to normal cognition, which is associated with multiple factors previously noted. Findings may enhance MCI prognostic accuracy and increase precision of early intervention studies of dementia.
背景/目的:很少有研究探讨轻度认知障碍(MCI)恢复至正常认知的预测因素。我们试图利用美国国立阿尔茨海默病协调中心统一数据集,通过比较恢复至正常认知的MCI个体与进展为痴呆症的个体,来确定恢复的基线预测因素。
符合MCI标准的参与者(n = 1208)在基线访视时以及随后的3次年度访视中接受评估。MCI恢复的基线预测因素集群包括人口统计学/遗传数据、整体功能、神经心理功能、医疗健康/痴呆风险评分以及神经精神症状。逐步逻辑回归模型确定了每个集群中MCI恢复的预测因素,然后将这些因素纳入最终的综合模型以找出总体预测因素。
在2年时,175人(14%)恢复至正常认知,612人(51%)仍为MCI,421人(35%)进展为痴呆症,3年时诊断持续存在。与MCI恢复相关的显著变量包括年龄较小、未婚、不存在APOE ε4等位基因、较低的CDR-SOB评分以及较高的记忆/语言测试分数。
相当一部分MCI个体恢复至正常认知,这与先前指出的多种因素相关。研究结果可能提高MCI的预后准确性,并提高痴呆症早期干预研究的精确性。