Poulin Stéphane P, Bergeron David, Dickerson Bradford C
Clinique Interdisciplinaire de la Mémoire, Centre Hositalier Universitaire de Québec, Quebec City, QC, Canada.
Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec (CRISUMQ), QC, Canada.
J Alzheimers Dis. 2017;60(2):483-493. doi: 10.3233/JAD-160767.
An integrative model of neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) is lacking.
In this study, we investigated the risk factors, anatomy, biology, and outcomes of NPS in AD.
181 subjects were included from the Alzheimer's Disease Neuroimaging Study (ADNI). NPS were assessed with the Neuropsychiatric Inventory Questionnaire at baseline and 6 months. NPI >3 was used as a threshold for NPS positivity. Three NPS courses were characterized: 1) minimal/absent (negative at 0 and 6 months, n = 77); 2) fluctuating (positive only at one time point, n = 53); 3) persistent (positive at both time points, n = 51). We examined the association between NPS course and family history of dementia, personal history of psychiatric disorders, cerebrospinal fluid biomarkers, atrophy patterns, as well as longitudinal cognitive and functional measures at 12 and 24 months (MMSE, CDR-SOB, FAQ).
AD subjects with absent, fluctuating, or persistent NPS had similar CSF amyloid-β and tau levels. AD subjects with minimal/absent NPS had less personal history of psychiatric disorders (35%) than those with fluctuating (57%; p = 0.015) or persistent NPS (47%, not significant). At 24 months, AD subjects with persistent NPS had worse cognitive (MMSE; p = 0.05) and functional (CDR-SOB; p = 0.016) outcomes. Dorsolateral prefrontal atrophy was seen in persistent NPS, but not in fluctuating NPS.
Our results suggest that individuals with personal history of psychiatric disorders might be more vulnerable to develop NPS throughout the course of AD. The worst cognitive and functional outcomes associated with NPS in AD underscores the importance of monitoring NPS early in the disease course.
目前尚缺乏阿尔茨海默病（AD）神经精神症状（NPS）的综合模型。
在本研究中，我们调查了AD中NPS的危险因素、解剖学、生物学及预后情况。
从阿尔茨海默病神经影像学研究（ADNI）中纳入181名受试者。在基线和6个月时用神经精神科问卷评估NPS。NPI>3被用作NPS阳性的阈值。确定了三种NPS病程特征：1）极少/无（0个月和6个月时均为阴性，n = 77）；2）波动型（仅在一个时间点为阳性，n = 53）；3）持续型（两个时间点均为阳性，n = 51）。我们研究了NPS病程与痴呆家族史、精神疾病个人史、脑脊液生物标志物、萎缩模式以及12个月和24个月时的纵向认知和功能指标（MMSE、CDR-SOB、FAQ）之间的关联。
NPS极少/无、波动型或持续型的AD受试者脑脊液淀粉样蛋白-β和tau水平相似。NPS极少/无的AD受试者有精神疾病个人史的比例（35%）低于波动型（57%；p = 0.015）或持续型NPS（47%，无统计学意义）。在24个月时，NPS持续型的AD受试者认知（MMSE；p = 0.05）和功能（CDR-SOB；p = 0.016）预后较差。持续型NPS可见背外侧前额叶萎缩，而波动型NPS未见。
我们的结果表明，有精神疾病个人史的个体在AD病程中可能更容易出现NPS。AD中与NPS相关的最差认知和功能预后强调了在疾病病程早期监测NPS的重要性。
