Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China.
J Alzheimers Dis. 2018;66(2):497-515. doi: 10.3233/JAD-180476.
The conclusions about risk factors for rapid cognitive decline (RCD) in Alzheimer's disease (AD) and mild cognitive impairment (MCI) remain contradictory.
To explore the factors predicting RCD in AD and MCI.
We searched the PubMed, EMBASE, and the Cochrane Library from inception to May 27, 2017 for studies investigating factors associated with faster cognitive progression in AD and MCI. Effect sizes were meta-analyzed using fixed-effects and random-effects models.
Fifty-three studies with 14,330 patients (12,396 AD and 1,934 MCI) were included in the systematic review. The following factors were identified to increase the risk of RCD in AD: Apolipoprotein E4 (ApoE4) (SMD [95% CI]: 0.52 [0.06,0.98]), early age at onset (SMD [95% CI]: -0.42 [-0.71, -0.13]), high level of education (RR = 2.05, 95% CI = 1.26 to 3.33), early appearance of extrapyramidal signs (RR = 2.18; 95% CI = 1.30 to 3.67), and neuropsychiatric conditions including hallucination (RR = 2.01, 95% CI = 1.40 to 2.87), strolling (RR = 1.99, 95% CI = 1.38 to 2.86), agitation (RR = 1.66, 95% CI = 1.23 to 2.24), and psychosis (RR = 1.42, 95% CI = 1.07 to 1.89). Instead, advanced age (≥75 years) (RR = 0.96, 95% CI = 0.93 to 0.99), diabetes (RR = 0.57; 95% CI = 0.35 to 0.93), and multidrug therapy (RR = 0.61, 95% CI = 0.60 to 0.62) would lower the risk of RCD. Furthermore, systematic research also reviewed seven risk factors associated with RCD in MCI.
ApoE4, early onset, early appearance of extrapyramidal signs, high education level, and neuropsychiatric conditions might increase the risk of RCD while older age, diabetes, and multidrug therapy were the protective factors for AD.
关于阿尔茨海默病（AD）和轻度认知障碍（MCI）快速认知衰退（RCD）的危险因素的结论仍然存在矛盾。
探讨 AD 和 MCI 中 RCD 的预测因素。
我们检索了 PubMed、EMBASE 和 Cochrane 图书馆，以获取自成立至 2017 年 5 月 27 日研究 AD 和 MCI 中与更快认知进展相关因素的研究。使用固定效应和随机效应模型对效应大小进行荟萃分析。
系统综述纳入了 53 项研究，共 14330 例患者（12396 例 AD 和 1934 例 MCI）。确定了以下因素会增加 AD 中 RCD 的风险：载脂蛋白 E4（ApoE4）（SMD [95%CI]：0.52 [0.06，0.98]）、发病年龄早（SMD [95%CI]：-0.42 [-0.71，-0.13]）、高教育水平（RR=2.05，95%CI=1.26 至 3.33）、早发性锥体外系症状（RR=2.18；95%CI=1.30 至 3.67）以及包括幻觉（RR=2.01，95%CI=1.40 至 2.87）、散步（RR=1.99，95%CI=1.38 至 2.86）、激越（RR=1.66，95%CI=1.23 至 2.24）和精神病（RR=1.42，95%CI=1.07 至 1.89）在内的神经精神状况。相反，高龄（≥75 岁）（RR=0.96，95%CI=0.93 至 0.99）、糖尿病（RR=0.57；95%CI=0.35 至 0.93）和多药治疗（RR=0.61，95%CI=0.60 至 0.62）会降低 RCD 的风险。此外，系统研究还回顾了与 MCI 中 RCD 相关的七个危险因素。
ApoE4、早发、锥体外系症状早发、高教育水平和神经精神状况可能会增加 RCD 的风险，而年龄较大、糖尿病和多药治疗是 AD 的保护因素。
