Gerontopôle, INSERM U 1027, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, France.
Institut de Recherches Internationales Servier, Suresnes, France.
J Alzheimers Dis. 2019;70(1):25-34. doi: 10.3233/JAD-190025.
Neuropsychiatric symptoms (NPS) are prevalent in mild cognitive impairment (MCI), but we do not know much about their role in progression to dementia.
To investigate NPS and the risk of progression to probable Alzheimer's disease dementia (AD) among subjects with MCI.
96 MCI participants were followed for 4 years. Progression to probable AD was defined by the change of CDR total score from 0.5 to ≥1, reviewed by an expert consensus panel. NPS were determined using the Neuropsychiatric Inventory (NPI) 12-items. This study analyzed prognostic value of each NPI item and 5 sub-syndromes of NPS (apathy, psychosis, affective, hyperactivity, and vegetative) for prediction of progression to probable AD. A Cox proportional hazard model was used; hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with time dependent variable to compare the incidence of progression considering presence/absence of any NPS or sub-syndromes throughout the study.
The presence of symptoms "agitation/aggression", "delusions", and "aberrant motor behavior" significantly increased the risk of probable AD (HR = 3.9; 95% CI = 1.9-8.2; HR = 13.9; 95% CI = 4.1-48.9; HR = 4.3; 95% CI = 1.7-10.3, respectively). The presence of sub-syndromes "psychosis" and "hyperactivity" were also predictors of progression (HR = 14.0; 95% CI = 4.4-44.5; HR = 2.0; 95% CI = 1.1-3.7, respectively). These results did not change after adjusting by potential confounders.
Presence of delusions, agitation/aggression, and aberrant motor behavior is predictor of progression to probable AD.
神经精神症状（NPS）在轻度认知障碍（MCI）中较为常见，但我们对其在向痴呆进展中的作用知之甚少。
研究 MCI 患者的 NPS 与向可能的阿尔茨海默病痴呆（AD）进展的风险。
96 名 MCI 参与者随访 4 年。进展为可能的 AD 通过 CDR 总分从 0.5 变为≥1 来定义，由专家共识小组进行审查。使用神经精神病学问卷（NPI）的 12 项来确定 NPS。本研究分析了每个 NPI 项目和 NPS 的 5 个亚综合征（冷漠、精神病、情感、多动和植物神经）对预测向可能的 AD 进展的预后价值。使用 Cox 比例风险模型；使用时间相关变量估计风险比（HR）和 95%置信区间（CI），以考虑在整个研究期间是否存在任何 NPS 或亚综合征来比较进展的发生率。
症状“激越/攻击”、“妄想”和“异常运动行为”的存在显著增加了可能 AD 的风险（HR=3.9；95%CI=1.9-8.2；HR=13.9；95%CI=4.1-48.9；HR=4.3；95%CI=1.7-10.3）。亚综合征“精神病”和“多动”的存在也是进展的预测因素（HR=14.0；95%CI=4.4-44.5；HR=2.0；95%CI=1.1-3.7）。这些结果在调整潜在混杂因素后没有改变。
妄想、激越/攻击和异常运动行为的存在是向可能的 AD 进展的预测因素。
