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不同神经心理学轻度认知障碍亚型进展为阿尔茨海默病的风险:纵向研究的层次荟萃分析。

Risk of progression to Alzheimer's disease for different neuropsychological Mild Cognitive Impairment subtypes: A hierarchical meta-analysis of longitudinal studies.

机构信息

Department of Health Psychology.

Alzheimer Research Center.

出版信息

Psychol Aging. 2018 Nov;33(7):1007-1021. doi: 10.1037/pag0000294. Epub 2018 Oct 4.

DOI:10.1037/pag0000294
PMID:30284855
Abstract

Mild Cognitive Impairment (MCI) is a heterogeneous condition between normal aging and dementia. Upon neuropsychological testing, MCI can be divided into 4 groups: single-domain amnestic MCI (sd-aMCI), multiple-domain amnestic MCI (md-aMCI), single- and multiple-domain nonamnestic MCI (sd-naMCI, md-naMCI). Some controversy exists about whether the risk of progression to Alzheimer's disease (risk-AD) is increased in all MCI subtypes. We meta-analyzed the risk-AD for 4 MCI groups using random-effects metaregression with the Hierarchical Robust Variance Estimator and sample size, criterion for objective cognitive impairment, length of follow-up and source of recruitment as covariates. From a pool of 134 available studies, 81 groups from 33 studies ( = 4,907) were meta-analyzed. All the studies were rated as having a high risk of bias. aMCI is overrepresented in studies from memory clinics. Multivariate analyses showed that md-aMCI had a similar risk-AD relative to sd-aMCI, whereas both sd-naMCI and md-naMCI showed a lower risk-AD compared with sd-aMCI. The risk-AD was significantly associated with differences in sample sizes across studies and between groups within studies. md-aMCI had a similar risk-AD relative to sd-aMCI in studies from memory clinics and in studies in the community. Several potential sources of bias such as blindness of AD diagnosis, the MCI diagnosis approach and the reporting of demographics were associated with the risk-AD. This work provides important data for use in both clinical and research scenarios. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

摘要

轻度认知障碍 (MCI) 是介于正常衰老和痴呆之间的一种异质性状态。在神经心理学测试中,MCI 可分为 4 组:单领域遗忘型 MCI (sd-aMCI)、多领域遗忘型 MCI (md-aMCI)、单领域和多领域非遗忘型 MCI (sd-naMCI、md-naMCI)。关于所有 MCI 亚型进展为阿尔茨海默病 (风险-AD) 的风险是否增加,存在一些争议。我们使用随机效应荟萃回归和分层稳健方差估计,以风险-AD 为因变量,以样本量、客观认知障碍标准、随访时间和招募来源为协变量,对 4 种 MCI 组的风险-AD 进行荟萃分析。从 134 项可用研究中,我们对 33 项研究中的 81 组 ( = 4907) 进行了荟萃分析。所有研究的偏倚风险均被评为高风险。aMCI 在记忆诊所的研究中更为常见。多变量分析表明,md-aMCI 与 sd-aMCI 的风险-AD 相似,而 sd-naMCI 和 md-naMCI 的风险-AD 均低于 sd-aMCI。风险-AD 与研究间样本量差异以及研究内组间差异显著相关。在记忆诊所的研究和社区研究中,md-aMCI 的风险-AD 与 sd-aMCI 相似。一些潜在的偏倚来源,如 AD 诊断的盲目性、MCI 诊断方法和人口统计学的报告,与风险-AD 相关。这项工作为临床和研究场景提供了重要的数据。(PsycINFO 数据库记录(c)2018 APA,保留所有权利)。

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