Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Int J Geriatr Psychiatry. 2021 Feb;36(2):271-285. doi: 10.1002/gps.5420. Epub 2020 Sep 15.
To investigate the extent to which slow progression of dementia after diagnosis might be predicted from routine longitudinal healthcare data, in order to clarify characteristics of people who experience this outcome.
A retrospective observational study was conducted using data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register. This study included all patients receiving a first dementia diagnosis between 2006 and 2017, restricted to those with a baseline Mini-Mental State Examination (MMSE) score within 6 months of initial diagnosis of dementia and at least one MMSE score after 3 years post-diagnosis. Slow progression was defined as a change in MMSE score of -1, 0 or an increase at the follow-up point. This group was compared to the remainder with an MMSE decline of -2 or more.
Overall, 682 patients with slow progression were compared to 1045 with faster progression. In the confounder-adjusted multivariate logistic regression model, slow progression was more likely in younger patients (age 65-74 years; odds ratio: 1.18; 95% confidence intervals: 1.04-1.37), males (1.24; 1.01-1.53), those with moderate or severe dementia according to MMSE, patients with mixed-type dementia (2.06; 1.11-3.82) compared to Alzheimer's disease and less likely in those receiving acetylcholinesterase inhibitor (AChEI) treatment (0.57; 0.46-0.71).
Slow dementia progression after diagnosis was common in patients with mixed Alzheimer's and vascular dementia, younger age, males and non-receipt of AChEIs, possibly suggesting non-Alzheimer pathologies and clarifying such predictors is important, as there is currently very limited information on which to base prognosis estimates in post-diagnosis counselling.
从常规纵向医疗保健数据中探究痴呆症诊断后进展缓慢的程度，以便阐明出现这种结果的人群特征。
采用来自南伦敦和莫兹利国民保健信托基金会生物医学研究中心病例登记处的数据进行回顾性观察性研究。该研究纳入了 2006 年至 2017 年间接受首次痴呆诊断的所有患者，限于在初始痴呆诊断后 6 个月内基线迷你精神状态检查（MMSE）评分以及在诊断后 3 年至少有一次 MMSE 评分的患者。进展缓慢定义为 MMSE 评分变化为-1、0 或增加。将该组与 MMSE 下降≥2 的其余患者进行比较。
共有 682 例进展缓慢的患者与 1045 例进展较快的患者进行了比较。在调整混杂因素的多变量逻辑回归模型中，年龄在 65-74 岁的年轻患者（比值比：1.18；95%置信区间：1.04-1.37）、男性（1.24；1.01-1.53）、根据 MMSE 评估为中度或重度痴呆的患者、患有混合性痴呆的患者（2.06；1.11-3.82）的进展缓慢的可能性更高，而患有阿尔茨海默病的患者（比值比：0.67；0.52-0.86）的进展缓慢的可能性更低，接受乙酰胆碱酯酶抑制剂（AChEI）治疗的患者（比值比：0.57；0.46-0.71）的进展缓慢的可能性更低。
在混合性阿尔茨海默病和血管性痴呆、年龄较小、男性和未接受 AChEI 治疗的患者中，诊断后痴呆进展缓慢较为常见，这可能提示存在非阿尔茨海默病的病理变化，阐明这些预测因素很重要，因为目前在诊断后咨询中，基于预后评估的信息非常有限。
