Neurology Department, Centro Hospitalar e Universitário de Lisboa Central, Alameda de Santo António dos Capuchos, 1169-050 Lisboa, Portugal.
Neurology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
Exp Gerontol. 2020 Sep;138:111004. doi: 10.1016/j.exger.2020.111004. Epub 2020 Jun 16.
Increasing evidence suggests that inflammation plays an important role in brain aging and neurodegeneration. Pathological studies demonstrate the presence of C-reactive protein (CRP) in the senile plaques and neurofibrillary tangles in Alzheimer's disease (AD) brain tissue suggesting that CRP may play a role in its neuropathological processes. Some findings suggest that midlife elevations of serum CRP are a risk factor for AD. However, others found lower CRP levels in mild or moderate AD than in controls, suggesting that CRP levels could be different in different stages of disease. We aimed to assess the role of CRP as a predictor of Mild cognitive impairment (MCI) conversion into AD dementia.
We retrospectively reviewed the cohort of MCI patients followed at the Dementia Clinic, Neurology Department of University Hospital of Coimbra. We collected demographical, neuropsychological, genetic and laboratorial variables (including serum CRP measurements at the time of baseline laboratory tests). A Cox regression model was performed adjusted for the collected variables preconsidered to be predictors of dementia and the variable being studied (CRP) to assess for independent predictors of conversion.
We included 130 patients, 58.5% female, with a mean age of onset of 65.5 ± 9.1 years and age at first assessment of 69.3 ± 8.5 years. The mean CRP was 0.33 ± 0.58 mg/dl. At follow-up (mean, 36.9 ± 27.0 months) 42.3% of MCI patients converted to dementia. Lower CSF Aβ42 (HR = 0.999, 95%CI = [0.997, 1.000], p = 0.015), lower MMSE score (HR = 0.864, 95%CI = [0.510, 1.595], p = 0.008) and lower CRP quartile (HR = 0.597, 95%CI = [0.435, 0.819], p = 0.001) were independent predictors of conversion.
CRP may add information of risk of conversion in MCI patients. Patients with lower CRP levels appear to have a more rapid conversion to AD dementia.
越来越多的证据表明，炎症在大脑衰老和神经退行性变中起着重要作用。病理学研究表明，C 反应蛋白（CRP）存在于阿尔茨海默病（AD）脑组织中的老年斑和神经原纤维缠结中，提示 CRP 可能在其神经病理过程中发挥作用。一些研究结果表明，中年时血清 CRP 升高是 AD 的危险因素。然而，其他人发现轻度或中度 AD 患者的 CRP 水平低于对照组，提示 CRP 水平在疾病的不同阶段可能不同。我们旨在评估 CRP 作为预测轻度认知障碍（MCI）转化为 AD 痴呆的指标的作用。
我们回顾性地审查了在科英布拉大学医院神经病学系痴呆诊所就诊的 MCI 患者队列。我们收集了人口统计学、神经心理学、遗传和实验室变量（包括基线实验室检查时的血清 CRP 测量值）。为了评估转化的独立预测因子，我们对考虑为痴呆预测因子的收集变量和正在研究的变量（CRP）进行了 Cox 回归模型分析。
我们纳入了 130 名患者，其中 58.5%为女性，发病年龄平均为 65.5±9.1 岁，首次评估年龄为 69.3±8.5 岁。平均 CRP 为 0.33±0.58mg/dl。在随访（平均 36.9±27.0 个月）期间，42.3%的 MCI 患者转化为痴呆。脑脊液 Aβ42 水平较低（HR=0.999，95%CI=[0.997，1.000]，p=0.015）、MMSE 评分较低（HR=0.864，95%CI=[0.510，1.595]，p=0.008）和 CRP 四分位数较低（HR=0.597，95%CI=[0.435，0.819]，p=0.001）是转化的独立预测因子。
CRP 可能为 MCI 患者的转化风险提供更多信息。CRP 水平较低的患者似乎向 AD 痴呆的转化速度更快。
