Viticchi Giovanna, Falsetti Lorenzo, Buratti Laura, Sajeva Giulia, Luzzi Simona, Bartolini Marco, Provinciali Leandro, Silvestrini Mauro
Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Italy.
J Alzheimers Dis. 2017;59(1):67-75. doi: 10.3233/JAD-170160.
Mild cognitive impairment (MCI) often represents the clinical manifestation of cognitive deterioration preceding Alzheimer's disease (AD). Currently, there are no reliable approaches for an objective evaluation of the risk of developing AD in MCI patients.
The aim of this study was to verify whether the Framingham cardiovascular risk profile (FCRP) could be useful to identify patients at the highest risk of conversion from MCI to AD.
Patients with amnestic MCI (aMCI) were carefully investigated to assess their vascular risk profile. They were also submitted to a comprehensive neuropsychological evaluation. The FCRP was calculated for each patient and the apolipoprotein E (ApoE) genotype was determined from peripheral blood cells. The main outcome was defined as a conversion to AD within 24 months after inclusion.
385 consecutive aMCI subjects were included. Age, FCRP, and vascular age showed a fairly predictive value on conversion to AD. Selecting the subpopulation of ApoE ɛ4 carriers, we observed that FCRP had an increased performance in predicting the conversion. The rate of conversion increased from 12.5% in the FCRP low-risk group to 43.2% in the high-risk group (p < 0.0001). ApoE ɛ4 carriers had a 3.7-times increased probability of conversion with respect to the other subjects (p < 0.0001).
FCRP assessment could be considered a reliable approach to predict conversion to AD in aMCI subjects. The presence of ApoE ɛ4 increases significantly the risk of conversion. These data confirm the narrow relationship between genetic and vascular risk factors in influencing the evolution of cognitive impairment.
轻度认知障碍（MCI）常表现为阿尔茨海默病（AD）之前认知功能衰退的临床表现。目前，尚无可靠方法可客观评估MCI患者发生AD的风险。
本研究旨在验证弗雷明汉心血管风险概况（FCRP）是否有助于识别从MCI转化为AD风险最高的患者。
对遗忘型MCI（aMCI）患者进行详细调查以评估其血管风险概况。他们还接受了全面的神经心理学评估。计算每位患者的FCRP，并从外周血细胞中确定载脂蛋白E（ApoE）基因型。主要结局定义为纳入后24个月内转化为AD。
纳入385例连续的aMCI受试者。年龄、FCRP和血管年龄对转化为AD具有一定的预测价值。选择ApoEɛ4携带者亚组，我们观察到FCRP在预测转化方面表现增强。转化率从FCRP低风险组的12.5%增加到高风险组的43.2%（p<0.0001）。与其他受试者相比，ApoEɛ4携带者转化的可能性增加3.7倍（p<0.0001）。
FCRP评估可被视为预测aMCI受试者转化为AD的可靠方法。ApoEɛ4的存在显著增加转化风险。这些数据证实了遗传和血管危险因素在影响认知障碍演变方面的密切关系。
