From the Department of Neuroscience (Z.L., T.K., Y.A.M., C.-C.L., N.Z., G.B.), Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences (M.G.H.), Division of Behavioral Neurology (G.S.D.), and Neuroscience Graduate Program (G.B.), Mayo Clinic, Jacksonville, FL; Division of Epidemiology, Department of Quantitative Health Sciences (M.V.), and Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; and Rush Alzheimer's Disease Center (D.A.B.), Rush University Medical Center, Chicago, IL.
Neurology. 2022 May 17;98(20):e2036-e2045. doi: 10.1212/WNL.0000000000200387. Epub 2022 Mar 21.
To identify clinicopathologic factors contributing to mild cognitive impairment (MCI) reversion to normal cognition.
We analyzed 3 longitudinal cohorts in this study: the Mayo Clinic Study of Aging (MCSA), the Religious Orders Study and Memory and Aging Project (ROSMAP), and the National Alzheimer's Coordinating Center (NACC). Demographic characteristics and clinical outcomes were compared between patients with MCI with or without an experience of reversion to normal cognition (referred to as reverters and nonreverters, respectively). We also compared longitudinal changes in cortical thickness, glucose metabolism, and amyloid and tau load in a subcohort of reverters and nonreverters in MCSA with MRI or PET imaging information from multiple visits.
We identified 164 (56.4%) individuals in MCSA, 508 (66.8%) individuals in ROSMAP, and 280 (34.1%) individuals in NACC who experienced MCI reversion to normal cognition. Cox proportional hazards regression models showed that MCI reverters had an increased chance of being cognitively normal at the last visit in MCSA (HR 3.31, 95% CI 2.14-5.12), ROSMAP (HR 3.72, 95% CI 2.50-5.56), and NACC (HR 9.29, 95% CI 6.45-13.40) and a reduced risk of progression to dementia (HR 0.12, 95% CI 0.05-0.29 in MCSA; HR 0.41, 95% CI 0.32-0.53 in ROSMAP; and HR 0.29, 95% CI 0.21-0.40 in NACC). Compared with MCI nonreverters, reverters had better-preserved cortical thickness (β = 0.082, <0.001) and glucose metabolism (β = 0.119, = 0.001) and lower levels of amyloid, albeit statistically nonsignificant (β = -0.172 = 0.090). However, no difference in tau load was found between reverters and nonreverters (β = 0.073, = 0.24).
MCI reversion to normal cognition is likely attributed to better-preserved cortical structure and glucose metabolism.
识别导致轻度认知障碍（MCI）向正常认知恢复的临床病理因素。
本研究分析了 3 个纵向队列：梅奥诊所老龄化研究（MCSA）、宗教秩序研究和记忆与衰老项目（ROSMAP）以及国家阿尔茨海默病协调中心（NACC）。比较了 MCI 患者中经历认知恢复正常（称为恢复者和未恢复者）和未经历认知恢复正常的患者之间的人口统计学特征和临床结局。我们还比较了 MCSA 中恢复者和未恢复者的皮质厚度、葡萄糖代谢以及淀粉样蛋白和 tau 负荷的纵向变化，这些信息来自多次访问的 MRI 或 PET 成像。
我们在 MCSA 中确定了 164 名（56.4%）经历 MCI 恢复正常认知的个体，在 ROSMAP 中确定了 508 名（66.8%）经历 MCI 恢复正常认知的个体，在 NACC 中确定了 280 名（34.1%）经历 MCI 恢复正常认知的个体。Cox 比例风险回归模型显示，MCI 恢复者在 MCSA（HR 3.31，95%CI 2.14-5.12）、ROSMAP（HR 3.72，95%CI 2.50-5.56）和 NACC（HR 9.29，95%CI 6.45-13.40）的最后一次随访中认知正常的可能性更高，认知进展为痴呆的风险更低（HR 0.12，95%CI 0.05-0.29 在 MCSA；HR 0.41，95%CI 0.32-0.53 在 ROSMAP；HR 0.29，95%CI 0.21-0.40 在 NACC）。与 MCI 未恢复者相比，恢复者具有更好的皮质厚度（β=0.082，<0.001）和葡萄糖代谢（β=0.119，=0.001），淀粉样蛋白水平较低，尽管统计学上无显著差异（β=-0.172，=0.090）。然而，在恢复者和未恢复者之间未发现 tau 负荷的差异（β=0.073，=0.24）。
MCI 向正常认知的恢复可能归因于更好的皮质结构和葡萄糖代谢。
