Levada Oleg A, Cherednichenko Nataliya V, Troyan Alexandra S
State Institution "Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine", Zaporizhzhia, Ukraine.
Front Psychiatry. 2017 May 4;8:75. doi: 10.3389/fpsyt.2017.00075. eCollection 2017.
The diagnostic construct of mild neurocognitive disorders (MNCDs) is substantially congruent with previously proposed criteria for mild cognitive impairment (MCI). MNCD/MCI is associated with neuropsychiatric symptoms (NPS). Previous studies have examined the prevalence of NPS in amnestic and non-amnestic MCI subtypes; however, no studies exist for etiological types of MNCD. We aimed to estimate the prevalence of NPS in patients with MNCD due to Alzheimer's disease (MNCD-AD) and subcortical vascular MNCD (ScVMNCD) and to determine whether NPS would expand these MNCD phenotypes.
The sample comprised 70 patients with MNCD-AD, 70 patients with ScVMNCD, and 55 cognitively normal elderly persons (CNEP). The diagnosis of MNCD-AD was made according to DSM-5 criteria for possible MNCD-AD. ScVMNCD patients fulfilled the DSM-5 criteria of the probable vascular MNCD and the diagnostic criteria for subcortical vascular MCI according to Frisoni et al. (1). The prevalence of NPS was based on the neuropsychiatric inventory. The statistical analyses included parametric and non-parametric tests, multivariate regression, and Spearman's correlation coefficient.
About 69.1% of CNEP, 97.1% of MNCD-AD, and 100% of ScVMNCD patients had one or more NPS. The prevalence of NPS in both MNCD groups was significantly higher than that in CNEP. The most prevalent NPS that had significant differential diagnostic value in separating MNCD-AD from ScVMNCD, as well as MNCD from CNEP, were anxiety (81.43%) and irritability (67.14%) in MNCD-AD and depression (81.43%) in ScVMNCD. In both MNCD groups, we observed significant ( < 0.05) correlations between all distinguishing NPS and the differential cognitive disturbances: the amnestic syndrome in MNCD-AD and executive dysfunction in ScVMNCD.
NPS occur in the majority of persons with MNCD-AD and ScVMNCD. Anxiety and irritability are the most prevalent NPS in MNCD-AD, as well as depression in ScVMNCD. The amnestic-anxious-irritable syndrome can be the main phenotype in MNCD-AD, on the other hand, the dysexecutive-depressive syndrome can be considered as the most prevalent clinical manifestation in ScVMNCD. Obtained data may be used for clinical differentiation of MNCD-AD and ScVMNCD patients.
轻度神经认知障碍（MNCD）的诊断结构与先前提出的轻度认知障碍（MCI）标准基本一致。MNCD/MCI与神经精神症状（NPS）相关。先前的研究已经调查了遗忘型和非遗忘型MCI亚型中NPS的患病率；然而，尚无关于MNCD病因类型的研究。我们旨在估计阿尔茨海默病所致MNCD（MNCD-AD）和皮质下血管性MNCD（ScVMNCD）患者中NPS的患病率，并确定NPS是否会扩展这些MNCD表型。
样本包括70例MNCD-AD患者、70例ScVMNCD患者和55例认知正常的老年人（CNEP）。MNCD-AD的诊断根据DSM-5中可能的MNCD-AD标准进行。ScVMNCD患者符合DSM-5中可能的血管性MNCD标准以及Frisoni等人（1）提出的皮质下血管性MCI诊断标准。NPS的患病率基于神经精神科问卷。统计分析包括参数检验和非参数检验、多元回归以及Spearman相关系数。
约69.1%的CNEP、97.1%的MNCD-AD患者和100%的ScVMNCD患者有一项或多项NPS。两个MNCD组中NPS的患病率均显著高于CNEP组。在区分MNCD-AD与ScVMNCD以及MNCD与CNEP方面具有显著鉴别诊断价值的最常见NPS，在MNCD-AD中是焦虑（81.43%）和易激惹（67.14%），在ScVMNCD中是抑郁（81.43%）。在两个MNCD组中，我们观察到所有有鉴别意义的NPS与不同的认知障碍之间存在显著（<0.05）相关性：MNCD-AD中的遗忘综合征和ScVMNCD中的执行功能障碍。
NPS在大多数MNCD-AD和ScVMNCD患者中出现。焦虑和易激惹是MNCD-AD中最常见的NPS，抑郁是ScVMNCD中最常见的NPS。遗忘-焦虑-易激惹综合征可能是MNCD-AD的主要表型，另一方面，执行功能障碍-抑郁综合征可被认为是ScVMNCD最常见的临床表现。所得数据可用于MNCD-AD和ScVMNCD患者的临床鉴别。
