Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Apr 3;6(4):e239964. doi: 10.1001/jamanetworkopen.2023.9964.
The ability to separately explore 2 dimensions of self-awareness of memory function-increased and decreased awareness-in cognitively normal older adults provides an important opportunity to understand subtle changes in either direction in relation to risk of Alzheimer disease.
To investigate the association of a novel measure for self-awareness of memory function with future clinical progression in individuals who were cognitively normal at baseline.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Alzheimer's Disease Neuroimaging Initiative, a multicenter study. Participants were older adults who were cognitively normal (ie, Clinical Dementia Rating [CDR] global score of 0) at baseline and had at least 2 years of follow-up. Data were collected from June 2010 to December 2021 and pulled from the University of Southern California Laboratory of Neuro Imaging database on January 18, 2022. Clinical progression was defined as the first instance of 2 consecutive follow-up CDR scale global scores of 0.5 or greater.
A traditional awareness score was measured by calculating the mean discrepancy between the participant and their study partner's scores on the Everyday Cognition questionnaire. An unawareness or heightened awareness subscore was generated by capping item-level positive or negative differences at zero before averaging. The main outcome-risk of future clinical progression-was analyzed for each baseline awareness measure using Cox regression analysis. Longitudinal trajectories of each measure were additionally compared using linear mixed-effects models.
The 436-person sample included 232 (53.2%) female participants, with a mean (SD) age of 74.5 (6.7) years; 25 participants (5.7%) were Black, 14 (3.2%) Hispanic, and 398 (91.3%) White; and 91 participants (20.9%) clinically progressed over their period of observation. Survival analyses showed that a 1-point improvement on the unawareness subscore was associated with an 84% reduction in progression hazard (hazard ratio, 0.16 [95% CI, 0.07-0.35]; P < .001), or equivalently, a 1-point decrease was associated with a 540% increase in progression hazard (95% CI, 183% to 1347%), with no significant results for the heightened awareness or traditional scores.
In this cohort study of 436 cognitively normal older adults, unawareness, rather than heightened awareness, of memory decline was strongly associated with future clinical progression, providing further support that discordant self- and informant-reported cognitive decline may provide important information to practitioners.
在认知正常的老年人中，分别探索记忆功能自我意识的两个维度——增强和减弱的意识——提供了一个重要的机会，可以了解与阿尔茨海默病风险相关的任何一个方向的微妙变化。
研究一种新的记忆功能自我意识测量方法与基线认知正常个体未来临床进展的关系。
设计、地点和参与者：这项队列研究使用了来自阿尔茨海默病神经影像学倡议（Alzheimer's Disease Neuroimaging Initiative）的多中心研究数据。参与者为认知正常（即临床痴呆评定量表[Clinical Dementia Rating]全球评分 0）的老年人，至少有 2 年的随访。数据于 2010 年 6 月至 2021 年 12 月收集，并于 2022 年 1 月 18 日从南加州大学神经影像学实验室数据库中提取。临床进展定义为连续两次随访的临床痴呆评定量表全球评分均为 0.5 或更高的首次发生。
通过计算参与者与研究伙伴在日常认知问卷上的得分之间的平均差异来测量传统的意识得分。在平均之前，将项目级别的阳性或阴性差异上限设置为零，以生成无认知或增强的意识子分数。使用 Cox 回归分析，对每个基线意识测量的未来临床进展风险进行了主要结果分析。还使用线性混合效应模型比较了每个测量值的纵向轨迹。
436 人的样本包括 232 名（53.2%）女性参与者，平均（SD）年龄为 74.5（6.7）岁；25 名参与者（5.7%）为黑人，14 名（3.2%）为西班牙裔，398 名（91.3%）为白人；91 名参与者（20.9%）在观察期间出现临床进展。生存分析显示，无认知子分数提高 1 分与进展风险降低 84%相关（风险比，0.16[95%CI，0.07-0.35]；P<0.001），或相当于降低 1 分与进展风险增加 540%相关（95%CI，183%至 1347%），而警觉或传统评分无显著结果。
在这项对 436 名认知正常老年人的队列研究中，对记忆下降的无认知，而不是增强的认知，与未来的临床进展密切相关，这进一步支持了不一致的自我和知情人报告的认知下降可能为医生提供重要信息。
