Grewal Karl S, O'Connell Megan E, Kirk Andrew, MacDonald Stuart W S, Morgan Debra
Department of Psychology, University of Saskatchewan, Saskatoon, Canada.
Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada.
Appl Neuropsychol Adult. 2023 Nov-Dec;30(6):639-648. doi: 10.1080/23279095.2021.1970552. Epub 2021 Aug 29.
Increased intraindividual variability (IIV) has been linked to outcomes such as cognitive decline and dementia, suggesting IIV might add valuable diagnostic information beyond traditional neuropsychological interpretation. We explored whether a subtype of IIV, dispersion, can provide additional information for dementia diagnosis. In a sample of memory clinic patients, three cognitive status groups were identified: subjective cognitive impairment (SCI; = 85), amnestic mild cognitive impairment (a-MCI; = 16), and dementia due to Alzheimer's disease (AD; = 48). Dispersion was computed as intraindividual standard deviations across multiple neuropsychological measures within three cognitive domains (executive functioning; immediate and delayed memory) and was compared for each diagnostic group using profile analysis. Patients with AD and a-MCI demonstrated less dispersion than patients with SCI in delayed memory. Results support existing theoretic perspectives on cognitive variability and age-related cognitive decline but suggest floor effects underlie suppression of dispersion in amnestic cognitive presentations. Questions remain about the contribution of IIV beyond impressions of impairment versus no impairment in these constrained representations of cognitive domains. Future investigations should investigate variability in SCI groups against controls to examine whether observed dispersion similarities between SCI and a-MCI or AD in immediate memory and executive functioning are meaningful.
个体内变异性(IIV)增加与认知能力下降和痴呆等结果相关,这表明IIV可能会在传统神经心理学解释之外提供有价值的诊断信息。我们探讨了IIV的一种亚型——离散度,是否能为痴呆诊断提供额外信息。在一个记忆门诊患者样本中,确定了三个认知状态组:主观认知障碍(SCI;n = 85)、遗忘型轻度认知障碍(a-MCI;n = 16)和阿尔茨海默病所致痴呆(AD;n = 48)。离散度计算为三个认知领域(执行功能;即时和延迟记忆)内多个神经心理学测量的个体内标准差,并使用轮廓分析对每个诊断组进行比较。在延迟记忆方面,AD和a-MCI患者的离散度低于SCI患者。研究结果支持了关于认知变异性和年龄相关认知下降的现有理论观点,但表明下限效应是遗忘型认知表现中离散度受抑制的基础。在这些受限的认知领域表征中,除了损伤与无损伤的印象之外,IIV的贡献仍存在疑问。未来的研究应针对对照组调查SCI组的变异性,以检验在即时记忆和执行功能方面观察到的SCI与a-MCI或AD之间的离散度相似性是否有意义。