Park Sang Won, Kim Seongheon, Park Jeonghoon, Jang Jae Won, Kim SangYun
Department of Neuroscience, Kangwon National University School of Medicine, Chuncheon, Korea.
Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea.
Dement Neurocogn Disord. 2020 Dec;19(4):129-139. doi: 10.12779/dnd.2020.19.4.129.
To identify biomarkers for prediction of the progression to dementia in mild cognitive impairment (MCI) patients, evaluation of brain structure changes has been validated by a comprehensive visual grading scale (CVRS) through magnetic resonance imaging (MRI). In this study, we specifically elucidated for the cognitive change of MCI patients classified based on AT(N) pathological status classification during the follow-up period of 3 years through the CVRS.
The 301 patients with initial MCI visited at least once for follow-up period. The data used in this study were obtained from the Alzheimer's disease (AD) Neuroimaging Initiative study. Brain atrophy was assessed by CVRS using MRI. AT(N) profiles were classified by cerebrospinal fluid abnormality. Based on the AT(N) assessment, all individuals in this study were divided into 3 groups (normal state biomarker, suspected non-Alzheimer's pathology [SNAP], or Alzheimer's continuum). The cox regression was used to analyze the hazard ratios of CVRS for progression to dementia.
Sixty-three progressed and 238 remained stable to dementia and the CVRS (mean±standard deviation) had significant difference between progressive MCI and stable MCI (p<0.001). Univariate and multivariate cox regression results (p<0.001) showed the independence of initial CVRS as a predictor for the progression to dementia. Moreover, comparing the classified AT(N) pathology group, SNAP and AD, effectiveness of CVRS as a predictor was verified only in Alzheimer's continuum.
The initial CVRS score as a predictor of dementia progression was independently validated at the stage of Alzheimer's progression among AT(N) pathologically differentiated MCI.
为了识别预测轻度认知障碍（MCI）患者发展为痴呆症的生物标志物，通过磁共振成像（MRI）的综合视觉分级量表（CVRS）对脑结构变化进行评估已得到验证。在本研究中，我们通过CVRS特别阐明了在3年随访期内基于AT(N)病理状态分类的MCI患者的认知变化。
301例初始MCI患者在随访期至少就诊一次。本研究使用的数据来自阿尔茨海默病（AD）神经影像学倡议研究。使用MRI通过CVRS评估脑萎缩。通过脑脊液异常对AT(N)特征进行分类。基于AT(N)评估结果，本研究中的所有个体被分为3组（正常状态生物标志物、疑似非阿尔茨海默病病理[SNAP]或阿尔茨海默病连续体）。采用Cox回归分析CVRS进展为痴呆症的风险比。
63例进展为痴呆症，238例保持稳定，进展性MCI和稳定性MCI之间的CVRS（均值±标准差）存在显著差异（p<0.001）。单因素和多因素Cox回归结果（p<0.001）表明初始CVRS作为进展为痴呆症预测指标的独立性。此外，比较分类后的AT(N)病理组、SNAP和AD，仅在阿尔茨海默病连续体中验证了CVRS作为预测指标的有效性。
在AT(N)病理分化的MCI中，阿尔茨海默病进展阶段，初始CVRS评分作为痴呆症进展预测指标得到独立验证。
