Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore.
Department of Pharmacology, National University of Singapore, Singapore, Singapore.
J Alzheimers Dis. 2020;73(3):1053-1062. doi: 10.3233/JAD-190999.
Cerebral small vessel disease (SVD) and neuropsychiatric symptoms (NPS) independently increase the risk of cognitive decline. While their co-existence has been reported in the preclinical stage of dementia, longitudinal data establishing the prognosis of their associations, especially in an Asian context remains limited.
This study investigated the role of SVD and NPS progressions on cognitive outcomes over 2 years in a dementia-free elderly cohort.
170 dementia-free elderly with baseline and 2-year neuropsychological assessments and MRI scans were included in this study. White matter hyperintensities (WMH), lacunes, and microbleeds (CMBs) were graded as markers of SVD. The Neuropsychiatric Inventory (NPI) was used to measure NPS. Generalized estimating equations modelling evaluated the relationship between NPI change and SVD progression. Logistic regression evaluated the risk of incident cognitive decline with both SVD and NPS. All models were adjusted for demographics, baseline cerebrovascular diease, and medial temporal lobe atrophy.
Higher NPI scores were associated with higher SVD burden at baseline. Subjects with WMH progression had greater increase in total NPI (β[SE] = 0.46[0.19], p = 0.016), driven by hyperactivity subsyndrome (β[SE] = 0.88[0.34], p = 0.007). Subjects with incident CMBs had greater increase in psychosis subsyndrome (β[SE] = 0.89[0.30], p < 0.001). Subjects with progressions in both SVD and NPS were more likely to develop cognitive decline over 2 years (OR[95% CI] = 4.17[1.06-16.40], p < 0.05).
Our findings support worsening of NPS as a clinical indicator of SVD progression and are associated with cognitive decline over 2 years. Early detection of NPS and targeted interventions on SVD burden may improve NPS outcomes.
脑小血管病（SVD）和神经精神症状（NPS）独立增加认知能力下降的风险。虽然它们在痴呆的临床前阶段已经被报道共存，但在亚洲背景下，关于它们之间关联的预后的纵向数据仍然有限。
本研究旨在调查 SVD 和 NPS 的进展在 2 年内对无痴呆老年队列认知结果的影响。
本研究纳入了 170 名无痴呆老年患者，他们在基线和 2 年内进行了神经心理学评估和 MRI 扫描。脑白质高信号（WMH）、腔隙和微出血（CMB）被分级为 SVD 的标志物。神经精神问卷（NPI）用于测量 NPS。广义估计方程模型评估了 NPI 变化与 SVD 进展之间的关系。Logistic 回归评估了 SVD 和 NPS 对认知能力下降的风险。所有模型均调整了人口统计学、基线脑血管疾病和内侧颞叶萎缩。
较高的 NPI 评分与基线时更高的 SVD 负担相关。WMH 进展的患者 NPI 总分增加更多（β[SE] = 0.46[0.19]，p = 0.016），这主要是由于多动综合征的增加（β[SE] = 0.88[0.34]，p = 0.007）。发生 CMB 的患者精神病学综合征的增加更多（β[SE] = 0.89[0.30]，p < 0.001）。SVD 和 NPS 都进展的患者在 2 年内更有可能出现认知能力下降（OR[95%CI] = 4.17[1.06-16.40]，p < 0.05）。
我们的发现支持 NPS 的恶化作为 SVD 进展的临床指标，并与 2 年内的认知能力下降有关。早期发现 NPS 和针对 SVD 负担的靶向干预可能会改善 NPS 结局。
