主观认知主诉的自我报告在经验衍生的轻度认知障碍亚型中 24 个月的准确性逐渐降低。
Increasing Inaccuracy of Self-Reported Subjective Cognitive Complaints Over 24 Months in Empirically Derived Subtypes of Mild Cognitive Impairment.
机构信息
1Veterans Affairs San Diego Healthcare System,San Diego,California.
3San Diego State University/University of California San Diego,Joint Doctoral Program in Clinical Psychology,San Diego,California.
出版信息
J Int Neuropsychol Soc. 2018 Sep;24(8):842-853. doi: 10.1017/S1355617718000486.
OBJECTIVES
Although subjective cognitive complaints (SCC) are an integral component of the diagnostic criteria for mild cognitive impairment (MCI), previous findings indicate they may not accurately reflect cognitive ability. Within the Alzheimer's Disease Neuroimaging Initiative, we investigated longitudinal change in the discrepancy between self- and informant-reported SCC across empirically derived subtypes of MCI and normal control (NC) participants.
METHODS
Data were obtained for 353 MCI participants and 122 "robust" NC participants. Participants were classified into three subtypes at baseline via cluster analysis: amnestic MCI, mixed MCI, and cluster-derived normal (CDN), a presumptive false-positive group who performed within normal limits on neuropsychological testing. SCC at baseline and two annual follow-up visits were assessed via the Everyday Cognition Questionnaire (ECog), and discrepancy scores between self- and informant-report were calculated. Analysis of change was conducted using analysis of covariance.
RESULTS
The amnestic and mixed MCI subtypes demonstrated increasing ECog discrepancy scores over time. This was driven by an increase in informant-reported SCC, which corresponded to participants' objective cognitive decline, despite stable self-reported SCC. Increasing unawareness was associated with cerebrospinal fluid Alzheimer's disease biomarker positivity and progression to Alzheimer's disease. In contrast, CDN and NC groups over-reported cognitive difficulty and demonstrated normal cognition at all time points.
CONCLUSIONS
MCI participants' discrepancy scores indicate progressive underappreciation of their evolving cognitive deficits. Consistent over-reporting in the CDN and NC groups despite normal objective cognition suggests that self-reported SCC do not predict impending cognitive decline. Results demonstrate that self-reported SCC become increasingly misleading as objective cognitive impairment becomes more pronounced. (JINS, 2018, 24, 842-853).
目的
尽管主观认知主诉（SCC）是轻度认知障碍（MCI）诊断标准的一个组成部分，但先前的研究结果表明，它们可能无法准确反映认知能力。在阿尔茨海默病神经影像学倡议中，我们研究了在基于经验的 MCI 和正常对照（NC）参与者的亚型中，自我报告和知情者报告的 SCC 之间的差异在纵向的变化。
方法
我们获得了 353 名 MCI 参与者和 122 名“稳健”NC 参与者的数据。通过聚类分析，在基线时将参与者分为三个亚型：遗忘型 MCI、混合 MCI 和聚类衍生的正常（CDN），这是一个假定的假阳性组，他们在神经心理学测试中表现正常。使用日常生活认知问卷（ECog）评估基线和两次年度随访时的 SCC，计算自我报告和知情者报告之间的差异得分。使用协方差分析进行变化分析。
结果
遗忘型和混合 MCI 亚型随着时间的推移表现出 ECog 差异得分的增加。这是由知情者报告的 SCC 增加驱动的，这与参与者的客观认知下降相对应，尽管自我报告的 SCC 稳定。认知不察觉的增加与脑脊液阿尔茨海默病生物标志物阳性和进展为阿尔茨海默病相关。相比之下，CDN 和 NC 组过高报告认知困难，并且在所有时间点都表现出正常认知。
结论
MCI 参与者的差异得分表明他们对不断发展的认知缺陷的认识逐渐减少。尽管客观认知正常，但 CDN 和 NC 组的一致性过高报告表明，自我报告的 SCC 并不能预测即将发生的认知下降。结果表明，随着客观认知障碍变得更加明显，自我报告的 SCC 变得越来越具有误导性。
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