Gad A. Marshall, MD, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, 60 Fenwood Road, 9016P, Boston, MA 02115, P: 617-732-8085, F: 617-264-6831, E:
J Prev Alzheimers Dis. 2022;9(4):801-808. doi: 10.14283/jpad.2022.58.
Performance of cognitively complex "instrumental activities of daily living" (IADL) has previously been related to amyloid deposition in preclinical Alzheimer's disease.
We aimed to investigate the relationship between IADL performance and cerebral tau accumulation in cognitively normal older adults.
Cross-sectional.
Data was collected in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) studies.
Participants (n = 447, age 71.9±4.9 years, 57.5% female) who underwent tau positron emission tomography were selected from the A4 and LEARN studies.
IADL performance was measured using the self- and study partner-reported versions of the Alzheimer's Disease Cooperative Study Activities of Daily Living - Prevention Instrument (ADCS ADL-PI). We also investigated discordance between participants and their study partners. Cross-sectional associations between entorhinal and inferior temporal tau (independent variables) and ADCS ADL-PI total scores, item-level scores and discordance (dependent variables) were investigated in linear and logistic regressions. Analyses were adjusted for age, sex and education and a tau by amyloid interaction was also included.
Participants and their study partners reported high levels of IADL performance. Entorhinal and inferior temporal tau were related to study partner but not to self-reported total ADCS ADL-PI scores. The association was not retained after adjustment for global cerebral amyloid burden. At the item level, greater entorhinal tau was associated with study partner-reported difficulties remembering important dates (odds ratio (OR) = 1.24, 95% confidence interval (95%CI) = [1.06, 1.45], p = 0.008) and difficulties remembering the details of TV programs and movies (OR = 1.32, 95%CI = [1.08, 1.61], p = 0.007). Greater inferior temporal tau was associated with self-reported difficulties managing to find personal belongings (OR = 1.23, 95%CI = [1.04, 1.46], p = 0.018) and study partner-reported difficulties remembering the details of TV programs and movies (OR = 1.39, 95%CI = [1.11, 1.75], p = 0.005). Discordance between participant and study partner-report was more likely with greater entorhinal (OR = 1.18, 95%CI = [1.05, 1.33], p = 0.005) and inferior temporal tau burden (OR = 1.29, 95%CI = [1.10, 1.51], p = 0.002).
We found a cross-sectional relationship between study partner-reported everyday functioning and tau in cognitively normal older adults. Participants were more likely to self-report difficulties differently from their study partners when tau burden was higher. This may hint at an altered early-disease awareness of functional changes and underscores the importance of self-report of IADL functioning in addition to collateral report by a study partner.
认知复杂的“日常生活活动”（IADL）的表现以前与临床前阿尔茨海默病中的淀粉样蛋白沉积有关。
我们旨在研究认知正常的老年人中 IADL 表现与脑 tau 积累之间的关系。
横断面。
数据来自于抗淀粉样蛋白治疗无症状阿尔茨海默病（A4）和淀粉样蛋白风险和神经退行性变的纵向评估（LEARN）研究。
从 A4 和 LEARN 研究中选择了 447 名接受 tau 正电子发射断层扫描的参与者（年龄 71.9±4.9 岁，57.5%为女性）。
使用阿尔茨海默病合作研究日常生活活动-预防工具（ADCS ADL-PI）的自我和研究伙伴报告版本来衡量 IADL 表现。我们还调查了参与者与其研究伙伴之间的差异。使用线性和逻辑回归研究了内嗅皮质和下颞叶 tau（自变量）与 ADCS ADL-PI 总分、项目水平得分和差异（因变量）之间的横断面关联。分析调整了年龄、性别和教育因素，并包括 tau 与淀粉样蛋白的相互作用。
参与者及其研究伙伴报告了高水平的 IADL 表现。内嗅皮质和下颞叶 tau 与研究伙伴相关，但与自我报告的总 ADCS ADL-PI 得分无关。在调整了全球脑淀粉样蛋白负担后，这种关联就不存在了。在项目水平上，更大的内嗅皮质 tau 与研究伙伴报告的难以记住重要日期（优势比（OR）=1.24，95%置信区间（95%CI）=[1.06，1.45]，p=0.008）和难以记住电视节目和电影的细节（OR=1.32，95%CI=[1.08，1.61]，p=0.007）有关。更大的下颞叶 tau 与自我报告难以找到个人物品（OR=1.23，95%CI=[1.04，1.46]，p=0.018）和研究伙伴报告难以记住电视节目和电影的细节（OR=1.39，95%CI=[1.11，1.75]，p=0.005）有关。内嗅皮质（OR=1.18，95%CI=[1.05，1.33]，p=0.005）和下颞叶 tau 负担（OR=1.29，95%CI=[1.10，1.51]，p=0.002）的差异越大，参与者与研究伙伴之间报告的差异就越明显。
我们发现认知正常的老年人中，研究伙伴报告的日常功能与 tau 之间存在横断面关系。当 tau 负担较高时，参与者更有可能与研究伙伴对自己的功能障碍有不同的自我报告。这可能暗示着早期疾病对功能变化的认识发生了变化，并强调了除了研究伙伴的旁证报告外，自我报告 IADL 功能的重要性。
