Department of Neurology and Laboratory of Functional Neurosciences, Amiens University Hospital, France.
J Alzheimers Dis. 2018;63(2):625-633. doi: 10.3233/JAD-171097.
The contrast between memory versus executive function impairments is commonly used to differentiate between neurocognitive disorders (NCDs) due to Alzheimer's disease (AD) and vascular cognitive impairment (VCI). We reconsidered this question because of the current use of AD biomarkers and the recent revision of the criteria for AD, VCI, and dysexecutive syndrome.
To establish and compare the neuropsychological profiles in AD (i.e., with positive CSF biomarkers) and in VCI.
We included 62 patients with mild or major NCDs due to pure AD (with positive CSF biomarker assays), and 174 patients (from the GRECogVASC cohort) with pure VCI. The neuropsychological profiles were compared after stratification for disease severity (mild or major NCD). We defined a memory-executive function index (the mean z score for the third free recall and the delayed free recall in the Free and Cued Selective Reminding Test minus the mean z score for category fluency and the completion time in the Trail Making Test part B) and determined its diagnostic accuracy.
Compared with VCI patients, patients with AD had significantly greater memory impairments (p = 0.001). Executive function was impaired to a similar extent in the two groups (p = 0.11). Behavioral executive disorders were more prominent in the AD group (p = 0.001). Although the two groups differed significant with regard to the memory-executive function index (p < 0.001), the latter's diagnostic accuracy was only moderate (sensitivity: 63%, specificity: 87%).
Although the contrast between memory and executive function impairments was supported at the group level it does not reliably discriminate between AD and VCI at the individual level.
记忆与执行功能损伤之间的差异通常用于区分阿尔茨海默病（AD）和血管性认知障碍（VCI）所致的神经认知障碍（NCD）。由于目前正在使用 AD 生物标志物，以及 AD、VCI 和执行功能障碍综合征的标准最近进行了修订，我们重新考虑了这个问题。
建立并比较 AD（即脑脊液生物标志物阳性）和 VCI 的神经心理学特征。
我们纳入了 62 例轻度或重度 NCD 患者（单纯 AD，脑脊液生物标志物检测阳性）和 174 例（来自 GRECogVASC 队列）单纯 VCI 患者。在按疾病严重程度（轻度或重度 NCD）分层后，比较了神经心理学特征。我们定义了一个记忆-执行功能指数（自由和线索选择性再认测试中第三次自由回忆和延迟自由回忆的平均 z 评分减去类别流畅性和 Trail Making Test 部分 B 的完成时间的平均 z 评分），并确定了其诊断准确性。
与 VCI 患者相比，AD 患者的记忆损伤明显更严重（p=0.001）。两组的执行功能损伤程度相似（p=0.11）。AD 组的行为执行障碍更为明显（p=0.001）。虽然两组在记忆-执行功能指数方面存在显著差异（p<0.001），但后者的诊断准确性仅为中等（敏感度：63%，特异性：87%）。
虽然在群体水平上支持记忆与执行功能损伤之间的差异，但在个体水平上，这种差异并不能可靠地区分 AD 和 VCI。
