Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
Istituto Nazionale di Fisica Nucleare (INFN), Genoa Section, Genoa, Italy.
J Alzheimers Dis. 2023;93(1):75-86. doi: 10.3233/JAD-220418.
Apathy is a frequent behavioral symptom of Alzheimer's disease (AD). The Apathy Evaluation Scale (AES) is a tool exploring the perception of apathy by both caregivers (CG-AES) and patients (PT-AES), and the discrepancy in their ratings is a proxy of patients' disease unawareness.
To assess in a cohort study of patients with amnesic mild cognitive impairment (aMCI) whether apathy and awareness of apathy predict progression to dementia and timing.
From the global AES scores of 110 patients with aMCI and their caregivers, we obtained two principal indices for analysis: 1) 'Apathy', the mean of PT-AES and CG-AES, and 2) 'Discrepancy', obtained by subtracting CG-AES from PT-AES. Patients were followed with visits every six months for three years or until dementia. AES indices and the principal demographical/neuropsychological variables were filtered from multicollinearity. The most robust variables entered a logistic regression model and survival analyses (Cox regression, log-rank test of Kaplan-Meier curves) to estimate which predicted the risk and timing of progression, respectively.
Sixty patients (54.5%) developed dementia (57 AD) after 6.0-36.0 months, 22 (20%) remained in an MCI stage, and 28 (25.5%) dropped out. 'Discrepancy' was a robust and accurate predictor of the risk of progression (AUC = 0.73) and, after binarization according to a computed cutoff, of timing to dementia.
A structured evaluation of apathy, both self-assessed and estimated by caregivers, can provide useful information on the risk and timing of progression from aMCI to dementia. The discrepancy between the two estimates is a fairly reliable index for prediction purposes as a proxy of disease unawareness.
冷漠是阿尔茨海默病（AD）的常见行为症状。冷漠评估量表（AES）是一种用于探索照顾者（CG-AES）和患者（PT-AES）对冷漠的感知的工具，他们评分的差异是患者疾病意识缺失的替代指标。
在一项遗忘型轻度认知障碍（aMCI）患者的队列研究中评估，冷漠和对冷漠的意识是否预测向痴呆的进展以及进展时间。
从 110 名 aMCI 患者及其照顾者的全球 AES 评分中，我们获得了两个用于分析的主要指标：1）“冷漠”，即 PT-AES 和 CG-AES 的平均值，2）“差异”，通过从 PT-AES 中减去 CG-AES 获得。对患者进行每六个月一次的随访，为期三年或直至痴呆。从多重共线性中筛选 AES 指数和主要人口统计学/神经心理学变量。最稳健的变量进入逻辑回归模型和生存分析（Cox 回归，Kaplan-Meier 曲线的对数秩检验），以分别估计哪些变量预测了进展的风险和时间。
60 名患者（54.5%）在 6.0-36.0 个月后发展为痴呆症（57 例 AD），22 名患者（20%）仍处于 MCI 阶段，28 名患者（25.5%）退出。“差异”是进展风险的可靠且准确预测指标（AUC=0.73），并且在根据计算的截止值进行二值化后，也是痴呆症时间的预测指标。
对冷漠进行结构化评估，包括自我评估和照顾者评估，可以为从 aMCI 向痴呆症的进展的风险和时间提供有用的信息。这两种估计之间的差异是一种相当可靠的预测指标，可作为疾病意识缺失的替代指标。
