Atayde Adrienne L, Fischer Corinne E, Schweizer Tom A, Munoz David G
Keenan Research Centre for Biomedical Research, the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Institute of Medical Sciences, University of Toronto, Toronto, Canada.
J Alzheimers Dis. 2020;74(3):839-850. doi: 10.3233/JAD-190907.
The relationship between sleep, neuropathology, and clinical manifestations of Alzheimer's disease (AD) remains controversial.
To determine whether nighttime behaviors (NTB) are associated with the development of AD histopathology or cognitive decline.
We compared NTB prevalence in subjects with or without AD lesions, and with or without progressive cognitive decline. Subjects with either absent or severe plaques and tangles were identified from the National Alzheimer's Disease Coordinating Center data sets and classified as cognitively declining if the standard deviation from their individual mean Mini-Mental Status Examination score was ≥2, and stable if <2 regardless of their initial score. NTB was assessed using the Neuropsychiatric Inventory Questionnaire Quick Version (NPI-Q).
NTB was significantly greater in decliners than stable subjects in the group with severe histopathology as determined by frequent plaques (p = 0.003) or high Braak stage (p = 0.002). A similar significant trend was observed in subjects with absent plaques (p = 0.019) or tangles (p = 0.006). The prevalence of NTB was comparable between stable AD and non-AD subjects. NTB severity scores showed a similar pattern.
The development of NTB as assessed by NPI-Q in subjects with or without AD lesions occurred concurrently with cognitive decline. Among cognitively stable subjects, the presence of AD histopathology did not alter NTB prevalence. Thus, NTB disruptions at the gross granularity level assessed by NPI-Q were much more closely related to cognitive decline than the formation of pathological lesions. Factors other than AD histopathology may mediate the association between NTB and cognitive decline.
睡眠、神经病理学与阿尔茨海默病（AD）临床表现之间的关系仍存在争议。
确定夜间行为（NTB）是否与AD组织病理学发展或认知衰退相关。
我们比较了有或无AD病变以及有或无进行性认知衰退的受试者的NTB患病率。从国家阿尔茨海默病协调中心数据集中识别出无斑块或有严重斑块和缠结的受试者，如果其简易精神状态检查表得分与其个体均值的标准差≥2，则分类为认知衰退，如果<2则为稳定，无论其初始得分如何。使用神经精神科问卷快速版（NPI-Q）评估NTB。
在由频繁斑块（p = 0.003）或高Braak分期（p = 0.002）确定的严重组织病理学组中，衰退者的NTB显著高于稳定受试者。在无斑块（p = 0.019）或缠结（p = 0.006）的受试者中也观察到类似的显著趋势。稳定的AD受试者和非AD受试者之间NTB患病率相当。NTB严重程度评分显示出类似模式。
无论有无AD病变，通过NPI-Q评估的NTB发展与认知衰退同时发生。在认知稳定的受试者中，AD组织病理学的存在并未改变NTB患病率。因此，通过NPI-Q在总体粒度水平评估的NTB破坏与认知衰退的关系比病理病变的形成更为密切。AD组织病理学以外的因素可能介导NTB与认知衰退之间的关联。
