Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
J Alzheimers Dis. 2018;62(2):699-711. doi: 10.3233/JAD-170365.
Alzheimer's disease (AD) and vascular dementia (VaD) lead to progressive decline in executive function. We estimated the prevalence of executive dysfunction in AD and VaD patients, investigating cognitive, functional, and clinical correlates and also using a multidimensional approach based on a standardized comprehensive geriatric assessment (CGA). We included 215 patients (115 AD patients and 100 VaD patients) consecutively evaluated with a complete cognitive and affective assessment, a CGA, and the Frontal Assessment Battery (FAB) with six subtests investigating conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. The prevalence of dysexecutive syndrome screened with a FAB score <12 points was high in both AD (97 patients) and VaD (77 patients) (84.3% versus 77.0%, p = 0.171). AD patients were significantly younger, with higher grade of cognitive impairment and less severe comorbidity and polypharmacy than VaD patients. AD patients showed a significantly higher impairment in FAB total score and five FAB subtests (conceptualization, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy) than VaD patients. These findings were largely confirmed in a sub-analysis conducted subdividing the sample in mild and moderate-to-severe demented patients and suggesting that in moderate-to-severe AD there was higher impairment in FAB total score and four FAB subtests (conceptualization, sensitivity to interference, inhibitory control, and environmental autonomy). Executive dysfunction could be greater in AD patients with moderate-to-severe dementia compared to VaD patients, although our groups were also not matched for age, comorbidity or polypharmacy, which could also exert an effect.
阿尔茨海默病（AD）和血管性痴呆（VaD）导致执行功能逐渐下降。我们评估了 AD 和 VaD 患者执行功能障碍的患病率，调查了认知、功能和临床相关性，并使用基于标准化全面老年评估（CGA）的多维方法。我们纳入了 215 名患者（115 名 AD 患者和 100 名 VaD 患者），他们接受了完整的认知和情感评估、CGA 和额叶评估量表（FAB）的测试，该量表有六个子测试，用于评估概念化、思维灵活性、运动编程、对干扰的敏感性、抑制控制和环境自主性。FAB 评分<12 分的执行功能障碍筛查在 AD（97 名患者）和 VaD（77 名患者）中均较高（84.3%对 77.0%，p=0.171）。AD 患者明显更年轻，认知障碍程度更高，合并症和多药治疗的严重程度较轻。AD 患者在 FAB 总分和五个 FAB 子测试（概念化、运动编程、对干扰的敏感性、抑制控制和环境自主性）中的损害明显更大。在对轻度和中重度痴呆患者进行亚组分析时，这些发现得到了广泛证实，并表明在中重度 AD 中，FAB 总分和四个 FAB 子测试（概念化、对干扰的敏感性、抑制控制和环境自主性）的损害更大。与 VaD 患者相比，中重度痴呆的 AD 患者的执行功能障碍可能更严重，尽管我们的两组患者在年龄、合并症或多药治疗方面也没有匹配，这也可能产生影响。
