Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Memory Aging & Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, China.
Neurobiol Aging. 2022 Jan;109:239-246. doi: 10.1016/j.neurobiolaging.2021.10.008. Epub 2021 Oct 22.
Comorbid neuropsychiatric symptoms are commonly found in individuals with dementia and is likely influenced by a combination of neurodegenerative and cerebrovascular pathophysiology. We evaluated the associations of a validated composite MRI-based quantitative measure of both neurodegeneration (hippocampus volume and cortical thickness of AD-specific regions) and cerebrovascular disease (CeVD; white matter hyperintensities and infarcts) with neuropsychiatric subsyndromes, and their interactions on cognition in a community-based sample across the disease spectrum (N = 773). Lower composite MRI scores corresponding to greater comorbid neurodegeneration and CeVD burden were associated with hyperactivity (OR = 1.48) and apathy (OR = 1.90) subsyndromes. Lower MRI scores with concomitant hyperactivity was associated with greater cognitive impairment, especially in patients who were at least moderately impaired, while the interaction with apathy was not dependent on disease stage. These MRI scores interaction models resulted in a better fit than models consisting of neurodegeneration or CeVD alone. Integrating multiple biomarkers with specific, disease stage-dependent neuropsychiatric subsyndromes may provide a more holistic risk profile to facilitate the identification of individuals at the highest risk of disease progression.
合并存在的神经精神症状在痴呆患者中很常见，可能受到神经退行性和脑血管病理生理学的综合影响。我们评估了经过验证的基于 MRI 的综合定量测量方法，该方法同时测量了神经退行性病变（海马体积和 AD 特定区域的皮质厚度）和脑血管疾病（CeVD；脑白质高信号和梗死）与神经精神亚综合征之间的相关性，以及它们在疾病谱中的社区样本中（N=773）对认知的相互作用。与合并存在的神经退行性病变和 CeVD 负担更重相对应的较低的复合 MRI 评分与多动（OR=1.48）和淡漠（OR=1.90）亚综合征相关。同时存在多动的较低 MRI 评分与更严重的认知障碍相关，尤其是在至少中度受损的患者中，而与淡漠的相互作用则不依赖于疾病阶段。这些 MRI 评分交互模型的拟合效果优于仅包含神经退行性病变或 CeVD 的模型。整合多种生物标志物与特定的、与疾病阶段相关的神经精神亚综合征，可能提供更全面的风险概况，有助于识别疾病进展风险最高的个体。
