不同认知特征与可能的阿尔茨海默病的进展率和死亡年龄相关。

Different Cognitive Profiles Are Associated with Progression Rate and Age at Death in Probable Alzheimer's Disease.

机构信息

Rush Alzheimer's Disease Center (RADC), Rush University Medical Center, Chicago, IL, USA.

Department of Neurology and Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA.

出版信息

J Alzheimers Dis. 2021;80(2):735-747. doi: 10.3233/JAD-201124.

DOI:10.3233/JAD-201124

PMID:33579838

Abstract

BACKGROUND

Cognitive profiles characterized by primarily language or visuospatial deficits have been documented in individuals meeting diagnostic criteria for probable Alzheimer's disease (AD), but their association with progression rate or overall survival is not well described.

OBJECTIVE

To compare time from diagnosis to severe disease stage and death in probable AD patients classified into three groups based on neuropsychological test performance: marked verbal impairment (Verb-PI) with relatively preserved visuospatial function, marked visuospatial impairment with preserved verbal function (Vis-PI), and balanced verbal and visuospatial impairments (Bal-PI).

METHODS

This prospective cohort study included 540 probable AD patients attending an academic memory clinic who were enrolled from 1995-2013 and followed annually. Eligible individuals had a Mini-Mental State Exam (MMSE) score ≥10 at baseline, and at least one annual follow up visit. We used Cox proportional hazards modeling to analyze the association of cognitive profiles with time to decline in MMSE and CDR Global Score.

RESULTS

Sixty-one (11.3%) individuals had a Verb-PI profile, 86 (16%) had a Vis-PI profile, and 393 (72.8%) a Bal-PI profile. MMSE decline to <10 was faster in Verb-PI than Vis-PI (HR 2.004, 95%CI, 1.062-3.780; p = 0.032). Progression to CDR-GS = 3 was faster in Verb-PI individuals compared to Bal-PI (HR 1.604, 95%CI, 1.022-2.515; p = 0.040) or Vis-PI (HR 2.388, 95%CI, 1.330-4.288; p = 0.004) individuals. Baseline cognitive profile did not affect mortality.

CONCLUSION

A recognition of different AD profiles may help to personalize care by providing a better understanding of pathogenesis and expected progression.

摘要

背景

在符合可能的阿尔茨海默病（AD）诊断标准的个体中，已经记录了以语言或视空间缺陷为主的认知特征，但它们与进展速度或总生存期的关系尚未得到很好的描述。

目的

根据神经心理学测试表现，将可能的 AD 患者分为三组：严重的语言障碍（Verb-PI）伴有相对保留的视空间功能、严重的视空间障碍伴有保留的语言功能（Vis-PI）和平衡的语言和视空间损伤（Bal-PI），比较三组患者从诊断到严重疾病阶段和死亡的时间。

方法

本前瞻性队列研究纳入了 1995 年至 2013 年期间在学术记忆诊所就诊的 540 名可能的 AD 患者，每年进行一次随访。合格的患者在基线时有 MMSE 评分≥10，并且至少有一次年度随访。我们使用 Cox 比例风险模型分析认知特征与 MMSE 和 CDR 全球评分下降时间的关系。

结果

61 名（11.3%）患者为 Verb-PI 型，86 名（16%）为 Vis-PI 型，393 名（72.8%）为 Bal-PI 型。与 Vis-PI 型相比，Verb-PI 型患者的 MMSE 下降到<10 更快（HR 2.004，95%CI，1.062-3.780；p=0.032）。与 Bal-PI 型（HR 1.604，95%CI，1.022-2.515；p=0.040）或 Vis-PI 型（HR 2.388，95%CI，1.330-4.288；p=0.004）相比，Verb-PI 型患者进展到 CDR-GS=3 的速度更快。基线认知特征不影响死亡率。