Department of Family Medicine, USC Keck School of Medicine, Alhambra, CA, USA.
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
J Alzheimers Dis. 2019;67(1):291-302. doi: 10.3233/JAD-180351.
This study aimed to determine if patterns of neuropsychological deficits, vascular risk factors, and neuropathology differ in Hispanic and Non-Hispanic patients with autopsy-confirmed Alzheimer's disease (AD). Participants were enrolled in a longitudinal study at the Shiley-Marcos AD Research Center at the University of California, San Diego. Hispanic (n = 14) and Non-Hispanic (n = 20) patients with autopsy-confirmed AD who scored ≥95 on the Dementia Rating Scale (DRS) were included. Patient groups were matched on age, education, global mental status, and severity of functional decline; they were compared to Hispanic (n = 14) or Non-Hispanic (n = 20) cognitively-normal controls of similar age and education. Ethnicity (Hispanic, Non-Hispanic) by disease state (autopsy-confirmed AD or cognitively normal) comparisons were made for cognitive test performance and vascular risk factors. Patient groups were further compared on measures of AD (Braak stage, neuritic plaques, neurofibrillary tangles), vascular neuropathology, and performance across cognitive domains of memory, language, attention, executive functions, and visuospatial abilities after scores were z-transformed based on respective culturally-appropriate control groups. Patient groups had similar overall AD pathology burden, whereas Hispanics with AD had more small parenchymal arteriolar disease and amyloid angiopathy than Non-Hispanics with AD. Despite largely similar pathology, Hispanics with AD were less cognitively impaired (relative to respective NC groups) than Non-Hispanics with AD, and exhibited a different pattern of deficits across cognitive domains. Findings suggest that cognitive deficits that are usually prominent in AD may be less salient in Hispanic patients and this may adversely impact the ability to clinically detect the disease in mild to moderate stages.
本研究旨在确定在经尸检证实的阿尔茨海默病（AD）的西班牙裔和非西班牙裔患者中，神经心理学缺陷、血管危险因素和神经病理学模式是否存在差异。参与者被招募到加利福尼亚大学圣地亚哥分校 Shiley-Marcos AD 研究中心的一项纵向研究中。包括经尸检证实的 AD 患者（n=14）和非西班牙裔（n=20），其 Dementia Rating Scale（DRS）评分≥95。患者组按年龄、教育程度、整体精神状态和功能下降严重程度进行匹配；与年龄和教育程度相似的西班牙裔（n=14）或非西班牙裔（n=20）认知正常对照进行比较。根据认知正常对照进行文化调整后，对认知测试表现和血管危险因素进行了疾病状态（经尸检证实的 AD 或认知正常）的种族（西班牙裔、非西班牙裔）比较。根据 Braak 分期、神经原纤维缠结、神经纤维缠结、血管神经病理学和记忆、语言、注意力、执行功能和视空间能力等认知领域的表现，进一步比较了患者组。尽管总体 AD 病理负担相似，但与非西班牙裔 AD 患者相比，患有 AD 的西班牙裔患者的小实质小动脉疾病和淀粉样血管病更多。尽管存在相似的病理，但与非西班牙裔 AD 患者相比，患有 AD 的西班牙裔患者的认知障碍程度较低（相对于各自的 NC 组），并且在认知领域表现出不同的缺陷模式。研究结果表明，在 AD 中通常较为突出的认知缺陷在西班牙裔患者中可能不那么明显，这可能会对在轻度至中度阶段临床检测疾病的能力产生不利影响。
