Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA.
J Alzheimers Dis. 2021;81(3):1131-1139. doi: 10.3233/JAD-200729.
Psychotic symptoms are an important and increasingly recognized aspect of Alzheimer's disease (AD). They have been shown to contribute to faster disease progression in clinic-based, demographically homogenous samples with high educational attainment.
We studied the association between baseline psychotic symptoms and disease progression among individuals with incident AD or 'at risk' of developing AD, from a demographically heterogenous, community-based cohort with minimal educational attainment.
212 participants received the Columbia University Scale of Psychopathology in Alzheimer's Disease scale. Participants had psychotic symptoms with any of: visual illusions, delusions, hallucinations, or agitation/aggression. Disease progression was measured yearly and defined by meeting cognitive (≤10 on the Folstein MMSE) or functional endpoints (≥10 on the Blessed Dementia Rating Scale or ≥4 on the Dependence Scale).
The mean age was 85 years old. The cohort was 78.3% female, 75.9% Hispanic, and had a mean 6.96 years of education. Within the follow-up period (mean: 3.69 years), 24 met the cognitive endpoint, 59 met the functional endpoint, and 132 met the cutoff for dependence. The presence of at least one psychotic symptom was initially associated with an increased risk of reaching the functional endpoint (HR 3.12, 95% CI 1.67-5.86, p < 0.001) and the endpoint of dependence (HR = 1.498, 95% CI 1.05-2.13, p = 0.03). However, these associations were attenuated and non-significant when adjusted for baseline functional status. Psychotic symptoms were not associated with the cognitive endpoint.
Psychotic symptoms may predict functional decline in patients of non-Caucasian ethnicity and with lower educational attainment.
精神病症状是阿尔茨海默病（AD）的一个重要且日益被认可的方面。在基于临床、人口同质且受教育程度较高的样本中，已表明精神病症状与更快的疾病进展有关。
我们研究了在人口异质、基于社区的、受教育程度较低的队列中，患有 AD 或有患 AD 风险的个体中，基线精神病症状与疾病进展之间的关联。
212 名参与者接受了哥伦比亚大学阿尔茨海默病精神病量表的评估。参与者有精神病症状，包括幻觉、妄想、幻觉或躁动/攻击。疾病进展每年进行测量，通过认知（Folstein MMSE 评分≤10）或功能终点（Blessed 痴呆评定量表≥10 或依赖量表≥4）来定义。
平均年龄为 85 岁。队列中 78.3%为女性，75.9%为西班牙裔，平均受教育年限为 6.96 年。在随访期间（平均 3.69 年），24 名参与者达到认知终点，59 名参与者达到功能终点，132 名参与者达到依赖的标准。至少存在一种精神病症状与达到功能终点（HR 3.12，95%CI 1.67-5.86，p<0.001）和依赖终点的风险增加相关（HR=1.498，95%CI 1.05-2.13，p=0.03）。然而，当调整基线功能状态后，这些关联减弱且不再显著。精神病症状与认知终点无关。
精神病症状可能预测非白种人群和受教育程度较低的患者的功能下降。
