冷漠作为轻度认知障碍转化为阿尔茨海默病的预测指标：德克萨斯阿尔茨海默病研究与护理联盟（TARCC）基于队列的分析

Apathy as a Predictor of Conversion from Mild Cognitive Impairment to Alzheimer's Disease: A Texas Alzheimer's Research and Care Consortium (TARCC) Cohort-Based Analysis.

作者信息

Salem Haitham, Suchting Robert, Gonzales Mitzi M, Seshadri Sudha, Teixeira Antonio L

机构信息

Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.

Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.

出版信息

J Alzheimers Dis. 2023;92(1):129-139. doi: 10.3233/JAD-220826.

DOI:10.3233/JAD-220826

PMID:36710674

Abstract

BACKGROUND

Apathy is among the neuropsychiatric symptoms frequently observed in people with cognitive impairment. It has been postulated to be a potential predictor of conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD).

OBJECTIVE

To detect conversion rates from MCI to AD, and to determine the effect of apathy on the progression to AD in patients with MCI enrolled in the Texas Alzheimer's Research and Care Consortium (TARCC) cohort.

METHODS

Apathy was determined by a positive response to the respective item in the Neuropsychiatric Inventory -Questionnaire (NPI-Q) completed by family members or caregivers. The final dataset included 2,897 observations from 1,092 individuals with MCI at the baseline. Kaplan-Meier survival curves were estimated to provide indices of the probability of conversion to AD over time across all individuals as well as between those with and without apathy. Cox proportional hazards regression measured the hazard associated with apathy and several other predictors of interest.

RESULTS

Over a period of 8.21 years, 17.3% of individuals had conversion from MCI to AD (n = 190 of 1,092 total individuals) across observations. The median time-to-conversion across all participants was 6.41 years. Comparing individuals with apathy (n = 158) versus without apathy (n = 934), 36.1% and 14.2% had conversion to AD, respectively. The median time-to-conversion was 3.79 years for individuals with apathy and 6.83 years for individuals without apathy. Cox proportional hazards regression found significant effects of several predictors, including apathy, on time-to-conversion. Age and cognitive performance were found to moderate the relationship between apathy and time-to-conversion.

CONCLUSIONS

Apathy is associated with progression from MCI to AD, suggesting that it might improve risk prediction and aid targeted intervention delivery.

摘要

背景

冷漠是认知障碍患者中常见的神经精神症状之一。据推测，它可能是轻度认知障碍（MCI）转化为阿尔茨海默病（AD）的一个潜在预测指标。

目的

检测MCI向AD的转化率，并确定冷漠对德克萨斯州阿尔茨海默病研究与护理联盟（TARCC）队列中MCI患者进展为AD的影响。

方法

通过家庭成员或照料者完成的神经精神科问卷（NPI-Q）中相应项目的阳性反应来确定冷漠。最终数据集包括来自1092名基线时患有MCI的个体的2897条观察数据。采用Kaplan-Meier生存曲线来估计所有个体以及有和没有冷漠症状的个体随时间转化为AD的概率指标。Cox比例风险回归分析测量了与冷漠及其他几个感兴趣的预测因素相关的风险。

结果

在8.21年的时间里，所有观察对象中有17.3%（共1092名个体中的190名）从MCI转化为AD。所有参与者转化的中位时间为6.41年。比较有冷漠症状的个体（n = 158）和无冷漠症状的个体（n = 934），分别有36.1%和14.2%转化为AD。有冷漠症状的个体转化的中位时间为3.79年，无冷漠症状的个体为6.83年。Cox比例风险回归分析发现包括冷漠在内的几个预测因素对转化时间有显著影响。发现年龄和认知表现会调节冷漠与转化时间之间的关系。