Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute.
Institute of Medical Sciences.
Alzheimer Dis Assoc Disord. 2018 Jul-Sep;32(3):185-189. doi: 10.1097/WAD.0000000000000250.
Despite having severe Alzheimer disease pathology, some individuals remain cognitively asymptomatic (cASYM). To explore noncognitive manifestations in these cASYM individuals, we aim to investigate the prevalence and pathologic substrates of psychosis.
Data were obtained from the National Alzheimer's Coordinating Center. The Neuropsychiatric Inventory Questionnaire, quick version was used to evaluate presence of psychosis. Subjects with Mini-Mental Status Examination score of ≥24 with frequent neuritic plaques (NPs) were defined as NPcASYM, and those with Braak and Braak stage of neurofibrillary tangles of V/VI were defined as NTcASYM (both groups collectively designated cASYM). Logistic regression analysis was used to examine the association between NP and neurofibrillary tangle severity and psychosis accounting for potential confounders.
We identified 667 subjects with Mini-Mental Status Examination score of ≥24, of which 137 were NPcASYM and 96 were NTcASYM. NPcASYM were at significantly higher risk of having psychosis compared with those with moderate or sparse/no NP (odds ratio, 2.47; 95% confidence interval, 1.54-3.96). NTcASYM were also at higher risk compared with those with Braak and Braak stage I to IV, but the association explained by the effect of Lewy body pathology and microinfarcts.
The load of NP may be an important substrate of psychosis in individuals who show no gross cognitive symptoms.
尽管患有严重的阿尔茨海默病病理学，但有些个体仍保持认知无症状（cASYM）。为了探究这些 cASYM 个体的非认知表现，我们旨在研究精神病的患病率和病理基础。
数据来自国家阿尔茨海默病协调中心。使用神经精神病学问卷快速版评估精神病的存在。简易精神状态检查评分≥24 且有频繁神经原纤维缠结（NPs）的患者被定义为 NPcASYM，而有 Braak 和 Braak V/VI 级神经纤维缠结的患者被定义为 NTcASYM（两组统称为 cASYM）。使用逻辑回归分析检查 NP 和神经纤维缠结严重程度与精神病之间的关联，考虑到潜在的混杂因素。
我们确定了 667 名简易精神状态检查评分≥24 的受试者，其中 137 名是 NPcASYM，96 名是 NTcASYM。NPcASYM 发生精神病的风险明显高于中度或稀疏/无 NP 的患者（优势比，2.47；95%置信区间，1.54-3.96）。与 Braak 和 Braak Ⅰ至Ⅳ期相比，NTcASYM 发生精神病的风险也更高，但这一关联可以用路易体病理和微梗死的影响来解释。
在没有明显认知症状的个体中，NP 的负荷可能是精神病的一个重要病理基础。
