轻度认知障碍和阿尔茨海默病患者神经精神症状的纵向评估及其与国家阿尔茨海默病协调中心统一数据集白质高信号的关系。
The Longitudinal Assessment of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Alzheimer's Disease and Their Association With White Matter Hyperintensities in the National Alzheimer's Coordinating Center's Uniform Data Set.
机构信息
University Health Network Memory Clinic, Department of Neurology, Toronto, Ontario, Canada; Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada.
McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
出版信息
Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Jan;6(1):70-78. doi: 10.1016/j.bpsc.2020.03.006. Epub 2020 Apr 2.
BACKGROUND
Neuropsychiatric symptoms (NPSs) are common in Alzheimer's disease (AD). NPSs contribute to patients' distress, caregiver burden, and institutionalization. White matter hyperintensities (WMHs) appear on magnetic resonance imaging, usually indicative of cerebrovascular disease. WMHs have been associated with certain NPSs. We aimed to assess the relationship between WMH and NPS severity in mild cognitive impairment (MCI) due to AD (MCI-AD) and in AD and to assess the ability of WMHs to predict NPS progression. Data were obtained from the National Alzheimer's Coordinating Center.
METHODS
A total of 252 participants (114 with MCI-AD and 138 with AD) were used in this study. Baseline WMHs were quantified using an automated segmentation technique. NPSs were measured using the Neuropsychiatric Inventory. Mixed-effect models and correlations were used to determine the relationship between WMHs and NPSs.
RESULTS
Longitudinal mixed-effect models revealed a significant relationship between increase in Neuropsychiatric Inventory total scores and baseline WMHs (p = .014). There was a significant relationship between baseline WMHs and an increase in delusions (p = .023), hallucinations (p = .040), agitation (p = .093), depression (p = .017), and irritability (p = .002). Correlation plot analysis showed that baseline whole-brain WMHs predicted change in future Neuropsychiatric Inventory total scores (r = .169, p = .008) and predicted change in future agitation severity scores (r = .165, p = .009). WMHs in the temporal lobes (r = .169, p = .008) and frontal lobes (r = .153, p = .016) contributed most to this change.
CONCLUSIONS
Depression, irritability, and agitation are common NPSs and very distressful to patients and caregivers. Our findings of increased NPS severity over time in MCI-AD and AD with increased WMHs have important implications for treatment, arguing for aggressive treatment of vascular risk factors in patients with MCI-AD or AD.
背景
神经精神症状（NPSs）在阿尔茨海默病（AD）中很常见。NPSs 会导致患者痛苦、照顾者负担和住院治疗。磁共振成像上出现的脑白质高信号（WMHs）通常表明存在脑血管疾病。WMHs 与某些 NPSs 有关。我们旨在评估轻度认知障碍（MCI）归因于 AD（MCI-AD）和 AD 患者中 WMH 与 NPS 严重程度之间的关系，并评估 WMH 预测 NPS 进展的能力。数据来自国家阿尔茨海默病协调中心。
方法
本研究共纳入 252 名参与者（114 名 MCI-AD 患者和 138 名 AD 患者）。使用自动分割技术量化基线 WMHs。使用神经精神问卷测量 NPSs。使用混合效应模型和相关性来确定 WMHs 与 NPSs 之间的关系。
结果
纵向混合效应模型显示，神经精神问卷总分的增加与基线 WMHs 之间存在显著关系（p=0.014）。基线 WMHs 与妄想（p=0.023）、幻觉（p=0.040）、激越（p=0.093）、抑郁（p=0.017）和易怒（p=0.002）的增加之间存在显著关系。相关图分析显示，全脑 WMHs 基线预测未来神经精神问卷总分的变化（r=0.169，p=0.008）和未来激越严重程度评分的变化（r=0.165，p=0.009）。颞叶（r=0.169，p=0.008）和额叶（r=0.153，p=0.016）的 WMHs 对这种变化的贡献最大。
结论
抑郁、易怒和激越是常见的 NPSs，对患者和照顾者来说非常痛苦。我们在 MCI-AD 和 AD 患者中发现，随着 WMHs 的增加，NPS 严重程度随时间增加，这对治疗具有重要意义，这表明在 MCI-AD 或 AD 患者中应积极治疗血管危险因素。
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