Prof. Lucilla Parnetti, Center for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Italy, E-mail address:
J Prev Alzheimers Dis. 2023;10(3):523-529. doi: 10.14283/jpad.2023.33.
In the perspective of novel treatments with disease-modifying drugs, a timely diagnosis of Alzheimer's' disease (AD) at preclinical phase represents a major issue. To this purpose, in clinical setting, there is the need to detect the earliest cognitive symptoms not yet fulfilling Mild Cognitive Impairment criteria, in order to proceed to biomarker assessment for diagnostic definition. In terms of cognitive performance, Subjective Cognitive Decline (SCD) is still a controversial entity, due to the difficulty of reliably measuring subtle deficits.
To evaluate the possibility to predict the presence of AD-like CSF pattern in SCD individuals, according to their neuropsychological performance assessed by means of both traditional and computerized measures.
Retrospective study.
Clinical setting (Centre for Memory Disturbances, Section of Neurology, University Hospital of Perugia, Italy).
74 consecutive SCD subjects who underwent an in-depth (paper-pencil and computerized) neuropsychological assessment and CSF analysis for AD biomarkers (Aβ42/Aβ40 ratio, phospho-tau, total tau).
Neuropsychological assessment was composed of traditional tests assessing five cognitive domains (verbal memory, attention, executive functions, language, visuo-spatial abilities) and computerized tasks from CAmbridge Neuropsychological Test Automated Battery (CANTAB) (Pattern Recognition Memory, Paired Associates Learning and Spatial Working Memory). According to their performance at traditional tests, SCD individuals were categorized into cognitively normal (CN) and subtle impaired (SI); with respect to CANTAB, they were defined as CANTAB- in presence of normal performance, and CANTAB+ in presence of at least one pathological score. The subgroup with completely normal performance was defined as CN/CANTAB-, and the subgroup with impairment in both measures as SI/CANTAB+. Differences in prevalence of A/T/N profile according to cognitive profiles were assessed by Fisher's exact text for count data.
None of CN/CANTAB- subjects showed A+/T+ status. SI/CANTAB+ subjects showed a significantly high prevalence of A+/T+ profile (14/35, 40%, p=0.03 vs CN/CANTAB-).
The neuropsychological profile may be of help in identifying SCD subjects requiring biomarker assessment. If confirmed in larger cohorts, the combination of traditional and computerized tests (namely, CANTAB) might represent a feasible strategy in clinical setting for carrying out biomarker assessment in individuals before the MCI stage. Detection of AD in these subjects would give them the highest chances to halt disease progression by means of disease modifying treatments.
在具有疾病修饰作用的新型治疗方法的视角下，在临床前阶段及时诊断阿尔茨海默病（AD）是一个主要问题。为此，在临床环境中，需要检测尚未满足轻度认知障碍标准的最早认知症状，以便进行生物标志物评估以明确诊断。在认知表现方面，主观认知下降（SCD）仍然是一个有争议的实体，因为可靠地测量细微缺陷具有一定难度。
根据通过传统和计算机化测量方法评估的神经心理学表现，评估 SCD 个体中存在类似 AD 的 CSF 模式的可能性。
回顾性研究。
意大利佩鲁贾大学医院记忆障碍中心，神经科。
74 例连续的 SCD 患者，他们接受了深入的（纸笔和计算机化）神经心理学评估和 CSF 分析，以检测 AD 生物标志物（Aβ42/Aβ40 比值、磷酸化 tau、总 tau）。
神经心理学评估由五项认知领域的传统测试组成（言语记忆、注意力、执行功能、语言、视空间能力）和剑桥神经心理学测试自动化电池（CANTAB）的计算机化任务（模式识别记忆、成对关联学习和空间工作记忆）。根据他们在传统测试中的表现，SCD 个体被分为认知正常（CN）和轻微受损（SI）；在 CANTAB 方面，他们被定义为 CANTAB-表现正常，以及 CANTAB+表现至少有一个病理评分。完全表现正常的亚组被定义为 CN/CANTAB-，而在两项测量中均受损的亚组被定义为 SI/CANTAB+。根据认知特征评估 A/T/N 特征的患病率差异采用 Fisher 精确检验进行计数数据。
CN/CANTAB-组无一例出现 A+/T+状态。SI/CANTAB+组 A+/T+ 特征的患病率显著升高（14/35，40%，p=0.03 与 CN/CANTAB-相比）。
神经心理学特征可能有助于识别需要生物标志物评估的 SCD 患者。如果在更大的队列中得到证实，传统和计算机化测试（即 CANTAB）的组合可能代表了在 MCI 阶段之前在个体中进行生物标志物评估的可行策略。在这些患者中检测到 AD 将使他们通过疾病修饰治疗来阻止疾病进展的机会最大。
