Choe Young Min, Byun Min Soo, Lee Jun Ho, Sohn Bo Kyung, Lee Dong Young, Kim Jee Wook
Department of Neuropsychiatry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea,
Department of Psychiatry, Hallym University College of Medicine, Chuncheon, Republic of Korea,
Neuropsychiatr Dis Treat. 2018 Sep 24;14:2451-2460. doi: 10.2147/NDT.S174517. eCollection 2018.
Despite their high prevalence in Alzheimer's disease (AD), and the increasing level of concern they have generated, subjective memory complaints (SMCs) are poorly understood. This study investigated the accuracy with which SMC can separate mild cognitive impairment (MCI) and early AD from cognitive normal (CN), and explored whether the discrimination ability is similar to or better than that of the Mini-Mental State Exam (MMSE).
This study recruited 175 CN subjects, 52 with MCI, and 66 with probable AD aged 60 years or older. To test the independent contributions of SMC and MMSE scores to the classification of cognitive status (CN vs MCI or early AD), logistic regression analyses were performed, adjusting for the following potential confounding variables: age, gender, Frontal Assessment Battery score, modified Hachinski Ischemic Scale score, and apolipoprotein E ε4 status. Receiver operating characteristic (ROC) curve analyses were used to determine the discrimination accuracy of SMC and MMSE scores, and area under the ROC curve (AUROC) was also calculated.
In the highly educated (≥7 years), nondepressed (Geriatric Depression Scale ≤15) subgroup, SMC showed good accuracy in discriminating cognitively impaired subjects from CN after adjusting for potential confounding variables (the AUROC of the adjusted SMC was 0.841 for MCI discrimination, and it was 0.858 for MCI plus early AD discrimination). Both SMC and MMSE scores significantly contributed to differentiating between CN and MCI (OR=2.372, 95% CI=1.086-5.177; OR=0.730, 95% CI=0.566-0.941, respectively) after adjusting for the same covariates. However, in the highly educated and nondepressed subgroups, SMC showed significant predictive power for MCI from CN (OR=3.119, 95% CI=1.190-8.176; OR=3.328, 95% CI=1.320-8.396, respectively), whereas MMSE scores did not.
Our findings support the usefulness of SMC, which was comparable or even superior to MMSE scores, for detecting MCI or early AD.
尽管主观记忆抱怨（SMCs）在阿尔茨海默病（AD）中普遍存在，且引发了越来越多的关注，但人们对其了解甚少。本研究调查了SMCs区分轻度认知障碍（MCI）和早期AD与认知正常（CN）的准确性，并探讨这种区分能力是否与简易精神状态检查表（MMSE）相似或更优。
本研究招募了175名60岁及以上的CN受试者、52名MCI患者和66名可能患有AD的患者。为了测试SMCs和MMSE评分对认知状态分类（CN与MCI或早期AD）的独立贡献，进行了逻辑回归分析，并对以下潜在混杂变量进行了调整：年龄、性别、额叶评估量表评分、改良哈金斯基缺血量表评分和载脂蛋白Eε4状态。采用受试者工作特征（ROC）曲线分析来确定SMCs和MMSE评分的区分准确性，并计算ROC曲线下面积（AUROC）。
在高学历（≥7年）、无抑郁（老年抑郁量表≤15）亚组中，在调整潜在混杂变量后，SMCs在区分认知受损受试者与CN方面显示出良好的准确性（调整后的SMCs的AUROC用于MCI区分时为0.841，用于MCI加早期AD区分时为0.858）。在调整相同协变量后，SMCs和MMSE评分均对区分CN和MCI有显著贡献（OR分别为2.372，95%CI为1.086 - 5.177；OR为0.730，95%CI为0.566 - 0.941）。然而，在高学历和无抑郁亚组中，SMCs对区分CN与MCI具有显著预测能力（OR分别为3.119，95%CI为1.190 - 8.176；OR为3.328，95%CI为1.320 - 8.396），而MMSE评分则没有。
我们的研究结果支持SMCs在检测MCI或早期AD方面的有用性，其与MMSE评分相当甚至更优。
