Veterans Affairs San Diego Healthcare System.
Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego.
Neuropsychology. 2018 Feb;32(2):235-245. doi: 10.1037/neu0000413.
Preclinical Alzheimer's disease (AD) defined by a positive AD biomarker in the presence of normal cognition is presumed to precede mild cognitive impairment (MCI). Subtle cognitive deficits and cognitive inefficiencies in preclinical AD may be detected through process and error scores on neuropsychological tests in those at risk for progression to MCI.
Cognitively normal participants (n = 525) from the Alzheimer's Disease Neuroimaging Initiative were followed for up to 5 years and classified as either stable normal (n = 305) or progressed to MCI (n = 220). Cox regressions were used to determine whether baseline process scores on the Rey Auditory Verbal Learning Test (AVLT; intrusion errors, learning slope, proactive interference, retroactive interference) predicted progression to MCI and a Clinical Dementia Rating (CDR) score of 1 after considering demographic characteristics, apolipoprotein E ε4 status, cerebrospinal fluid AD biomarkers, ischemia risk, mood, functional difficulty, and standard neuropsychological total test scores for the model.
Baseline AVLT intrusion errors predicted progression to MCI (hazard ratio = 1.04, 95% confidence interval 1.01-1.07, p = .008) and improved model fit after the other valuable predictors were already in the model, χ2(df = 1) = 6.330, p = .012. AVLT intrusion errors also predicted progression to CDR = 1 (hazard ratio = 1.10, 95% confidence interval 1.02-1.18, p = .016) and again improved model fit, χ2(df = 1) = 4.682, p = .030.
Intrusion errors on the AVLT contribute unique value for predicting progression from normal cognition to MCI and normal cognition to mild dementia (CDR = 1). Intrusion errors appear to reflect subtle change and inefficiencies in cognition that precede impairment detected by neuropsychological total scores. (PsycINFO Database Record
在认知正常的情况下，存在阿尔茨海默病（AD）阳性生物标志物被定义为临床前 AD，据推测其先于轻度认知障碍（MCI）。在有进展为 MCI 风险的患者中，通过神经心理学测试的过程和错误评分，可以检测到临床前 AD 中的细微认知缺陷和认知效率低下。
AD 神经影像学倡议中的认知正常参与者（n=525）随访长达 5 年，分为稳定正常组（n=305）或进展为 MCI 组（n=220）。使用 Cox 回归确定 Rey 听觉言语学习测试（AVLT；侵入错误、学习斜率、前摄干扰、后摄干扰）的基线过程评分是否预测进展为 MCI 和 CDR 评分为 1，同时考虑人口统计学特征、载脂蛋白 E ε4 状态、脑脊液 AD 生物标志物、缺血风险、情绪、功能困难和标准神经心理学总测试评分。
基线 AVLT 侵入错误预测向 MCI 的进展（风险比=1.04，95%置信区间 1.01-1.07，p=.008），并且在其他有价值的预测因子已经纳入模型后，提高了模型拟合度，χ2（df=1）=6.330，p=.012。AVLT 侵入错误也预测向 CDR=1 的进展（风险比=1.10，95%置信区间 1.02-1.18，p=.016），并再次提高了模型拟合度，χ2（df=1）=4.682，p=.030。
AVLT 上的侵入错误对预测从正常认知到 MCI 和正常认知到轻度痴呆（CDR=1）的进展具有独特的价值。侵入错误似乎反映了认知的细微变化和效率低下，这些变化和效率低下先于神经心理学总分检测到的损伤。
