Oltra-Cucarella Javier, Sánchez-SanSegundo Miriam, Lipnicki Darren M, Crawford John D, Lipton Richard B, Katz Mindy J, Zammit Andrea R, Scarmeas Nikolaos, Dardiotis Efthimios, Kosmidis Mary H, Guaita Antonio, Vaccaro Roberta, Kim Ki Woong, Han Ji Won, Kochan Nicole A, Brodaty Henry, Pérez-Vicente José A, Cabello-Rodríguez Luis, Sachdev Perminder S, Ferrer-Cascales Rosario
Department of Health Psychology, University of Alicante, Alicante, Spain.
Unit of Cognitive Impairments and Movement Disorders, Hospital General Universitario Santa María del Rosell, Cartagena, Spain.
Int Psychogeriatr. 2019 Jul;31(7):997-1006. doi: 10.1017/S104161021800145X.
To investigate whether amnestic mild cognitive impairment (aMCI) identified with visual memory tests conveys an increased risk of Alzheimer's disease (risk-AD) and if the risk-AD differs from that associated with aMCI based on verbal memory tests.
4,771 participants aged 70.76 (SD = 6.74, 45.4% females) from five community-based studies, each a member of the international COSMIC consortium and from a different country, were classified as having normal cognition (NC) or one of visual, verbal, or combined (visual and verbal) aMCI using international criteria and followed for an average of 2.48 years. Hazard ratios (HR) and individual patient data (IPD) meta-analysis analyzed the risk-AD with age, sex, education, single/multiple domain aMCI, and Mini-Mental State Examination (MMSE) scores as covariates.
All aMCI groups (n = 760) had a greater risk-AD than NC (n = 4,011; HR range = 3.66 - 9.25). The risk-AD was not different between visual (n = 208, 17 converters) and verbal aMCI (n = 449, 29 converters, HR = 1.70, 95%CI: 0.88, 3.27, p = 0.111). Combined aMCI (n = 103, 12 converters, HR = 2.34, 95%CI: 1.13, 4.84, p = 0.023) had a higher risk-AD than verbal aMCI. Age and MMSE scores were related to the risk-AD. The IPD meta-analyses replicated these results, though with slightly lower HR estimates (HR range = 3.68, 7.43) for aMCI vs. NC.
Although verbal aMCI was most common, a significant proportion of participants had visual-only or combined visual and verbal aMCI. Compared with verbal aMCI, the risk-AD was the same for visual aMCI and higher for combined aMCI. Our results highlight the importance of including both verbal and visual memory tests in neuropsychological assessments to more reliably identify aMCI.
研究通过视觉记忆测试识别出的遗忘型轻度认知障碍（aMCI）是否会增加患阿尔茨海默病（AD风险）的风险，以及基于言语记忆测试的aMCI所关联的AD风险是否与之不同。
来自五项基于社区的研究的4771名参与者，年龄为70.76岁（标准差=6.74，45.4%为女性），每项研究均为国际COSMIC联盟的成员且来自不同国家，根据国际标准被分类为认知正常（NC）或视觉、言语或联合（视觉和言语）aMCI之一，并平均随访2.48年。风险比（HR）和个体患者数据（IPD）荟萃分析以年龄、性别、教育程度、单/多领域aMCI和简易精神状态检查表（MMSE）分数作为协变量分析AD风险。
所有aMCI组（n = 760）患AD风险均高于NC组（n = 4011；HR范围=3.66 - 9.25）。视觉aMCI组（n = 208，17例转化者）和言语aMCI组（n = 449，29例转化者，HR = 1.70，95%CI：0.88，3.27，p = 0.111）之间的AD风险无差异。联合aMCI组（n = 103，12例转化者，HR = 2.34，95%CI：1.13，4.84，p = 0.023）患AD风险高于言语aMCI组。年龄和MMSE分数与AD风险相关。IPD荟萃分析重复了这些结果，尽管aMCI与NC相比HR估计值略低（HR范围=3.68，7.43）。
虽然言语aMCI最为常见，但相当一部分参与者存在仅视觉或视觉与言语联合的aMCI。与言语aMCI相比，视觉aMCI的AD风险相同，联合aMCI的AD风险更高。我们的结果强调了在神经心理学评估中纳入言语和视觉记忆测试以更可靠地识别aMCI的重要性。
