社区居住老年人的神经精神和认知亚型与 DSM-5 轻度神经认知障碍的关联：潜在类别分析。

Neuropsychiatric and Cognitive Subtypes among Community-Dwelling Older Persons and the Association with DSM-5 Mild Neurocognitive Disorder: Latent Class Analysis.

机构信息

Department of Geriatric Psychiatry, Institute of Mental Health, Singapore.

Saw Swee Hock School of Public Health, National University of Singapore, Singapore.

出版信息

J Alzheimers Dis. 2018;62(2):675-686. doi: 10.3233/JAD-170947.

DOI:10.3233/JAD-170947

PMID:29480192

Abstract

BACKGROUND

Neuropsychiatric symptoms (NPS) have been shown to increase the risk of neurocognitive disorders (NCD), leading to the recently-published criteria of mild behavioral impairment (MBI) to identify pre-dementia using NPS alone. However, MBI drew concerns about over-diagnosing subclinical psychiatric disorders.

OBJECTIVE

We hypothesized that the specificity of NPS in predicting NCD may be improved by considering NPS together with various domains of cognitive deficits. We tested this hypothesis by identifying subtypes based on the combination of NPS and cognitive deficits among community-dwelling older persons, and evaluating how the identified subtypes were associated with mild NCD.

METHODS

Our participants were from a community-based cohort study. They completed assessments such as Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), and Montreal Cognitive Assessment (MoCA). Those with possible cognitive impairment underwent further evaluations for mild NCD. Latent class analysis was conducted using GDS, GAI, and MoCA domains. Logistic regression was performed to investigate the association between the latent-classes and mild NCD.

RESULTS

We included 825 participants, and identified four distinct subtypes: Subtype 1 (no NPS or cognitive deficits), Subtype 2 (NPS alone), Subtype 3 (cognitive deficits alone), and Subtype 4 (both NPS and cognitive deficits). Subtype 1 and 2 had low risk of prevalent mild NCD (OR 0.92- 1.00), while Subtype 3 conferred a moderate risk (OR 4.47- 4.85) and Subtype 4 had the highest risk (OR 7.95- 8.63).

CONCLUSION

We demonstrated the benefits of combining NPS and cognitive deficits to predict those at highest risk of prevalent mild NCD. Our findings highlighted the relevance of subclinical psychiatric symptoms in predicting NCD, and indirectly supported the need for longer durations of NPS to improve its specificity.

摘要

背景

神经精神症状（NPS）已被证明会增加神经认知障碍（NCD）的风险，因此最近发布了轻度行为障碍（MBI）标准，以便仅使用 NPS 来识别痴呆前状态。然而，MBI 引起了对亚临床精神障碍过度诊断的担忧。

目的

我们假设通过考虑 NPS 与认知缺陷的各个领域相结合，NPS 预测 NCD 的特异性可能会提高。我们通过在社区居住的老年人中根据 NPS 和认知缺陷的组合来确定亚型，并评估所确定的亚型与轻度 NCD 的相关性来检验这一假设。

方法

我们的参与者来自一个基于社区的队列研究。他们完成了老年抑郁量表（GDS）、老年焦虑量表（GAI）和蒙特利尔认知评估（MoCA）等评估。那些有认知障碍可能的人接受了进一步的轻度 NCD 评估。使用 GDS、GAI 和 MoCA 领域进行潜在类别分析。进行逻辑回归以调查潜在类别与轻度 NCD 之间的关联。

结果

我们纳入了 825 名参与者，并确定了四个不同的亚型：亚型 1（无 NPS 或认知缺陷）、亚型 2（仅有 NPS）、亚型 3（仅有认知缺陷）和亚型 4（NPS 和认知缺陷均有）。亚型 1 和 2 发生现患轻度 NCD 的风险较低（OR 0.92-1.00），而亚型 3 则有中度风险（OR 4.47-4.85），亚型 4 风险最高（OR 7.95-8.63）。