Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Aging Ment Health. 2023 Nov-Dec;27(11):2187-2192. doi: 10.1080/13607863.2023.2227118. Epub 2023 Jun 24.
Due to the long prodromal period for dementia pathology, approaches are needed to detect cases before clinically recognizable symptoms are apparent, by which time it is likely too late to intervene. This study contrasted two theoretically-based algorithms for classifying early cognitive impairment (ECI) in adults aged ≥50 enrolled in the Baltimore Longitudinal Study of Aging.
Two ECI algorithms were defined as poor performance (1 standard deviation [SD] below age-, sex-, race-, and education-specific means) in: (1) Card Rotations or California Verbal Learning Test (CVLT) immediate recall and (2) ≥1 (out of 2) memory or ≥3 (out of 6) non-memory tests. We evaluated concurrent criterion validity against consensus diagnoses of mild cognitive impairment (MCI) or dementia and global cognitive scores using receiver operating characteristic (ROC) curve analysis. Predictive criterion validity was evaluated using Cox proportional hazards models to examine the associations between algorithmic status and future adjudicated MCI/dementia.
Among 1,851 participants (mean age = 65.2 ± 11.8 years, 50% women, 74% white), the two ECI algorithms yielded comparably moderate concurrent criterion validity with adjudicated MCI/dementia. For predictive criterion validity, the algorithm based on impairment in Card Rotations or CVLT immediate recall was the better predictor of MCI/dementia (HR = 3.53, 95%CI: 1.59-7.84) over 12.3 follow-up years.
Impairment in visuospatial ability or memory may be capable of detecting early cognitive changes in the preclinical phase among cognitively normal individuals.
由于痴呆病理的潜伏期较长，因此需要在出现临床可识别的症状之前，通过某些方法来检测病例，因为此时进行干预很可能为时已晚。本研究对比了两种基于理论的算法，用于对 50 岁及以上参加巴尔的摩纵向老龄化研究的成年人进行早期认知障碍（ECI）的分类。
将两种 ECI 算法定义为：（1）卡片旋转或加利福尼亚语言学习测试（CVLT）即时回忆中表现差（低于年龄、性别、种族和教育特定平均值 1 个标准差），或（2）记忆测试中≥1 项（2 项中的 1 项）或非记忆测试中≥3 项（6 项中的 3 项）异常。我们使用接收者操作特征（ROC）曲线分析评估了与轻度认知障碍（MCI）或痴呆的共识诊断以及全球认知评分的同时效标准有效性。使用 Cox 比例风险模型评估预测性标准有效性，以检验算法状态与未来确定的 MCI/痴呆之间的关联。
在 1851 名参与者中（平均年龄=65.2±11.8 岁，50%为女性，74%为白人），两种 ECI 算法与确定的 MCI/痴呆具有相当中等的同时效标准有效性。在预测性标准有效性方面，基于卡片旋转或 CVLT 即时回忆受损的算法是 MCI/痴呆的更好预测指标（HR=3.53，95%CI：1.59-7.84），随访时间为 12.3 年。
在认知正常个体的临床前阶段，视空间能力或记忆损伤可能能够检测到早期认知变化。
