检测高功能老年人的认知衰退：主观认知担忧、高神经心理测试分数频率与额顶叶控制网络之间的关系。
Detecting cognitive decline in high-functioning older adults: The relationship between subjective cognitive concerns, frequency of high neuropsychological test scores, and the frontoparietal control network.
作者信息
Karr Justin E, Hakun Jonathan G, Elbich Daniel B, Pinheiro Cristina N, Schmitt Frederick A, Segerstrom Suzanne C
机构信息
Department of Psychology, University of Kentucky, Lexington, KY, USA.
Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
出版信息
J Int Neuropsychol Soc. 2024 Mar;30(3):220-231. doi: 10.1017/S1355617723000607. Epub 2023 Sep 26.
OBJECTIVE
Neuropsychologists have difficulty detecting cognitive decline in high-functioning older adults because greater neurological change must occur before cognitive performances are low enough to indicate decline or impairment. For high-functioning older adults, early neurological changes may correspond with subjective cognitive concerns and an absence of high scores. This study compared high-functioning older adults with and without subjective cognitive concerns, hypothesizing those with cognitive concerns would have fewer high scores on neuropsychological testing and lower frontoparietal network volume, thickness, and connectivity.
METHOD
Participants had high estimated premorbid functioning (e.g., estimated intelligence ≥75th percentile or college-educated) and were divided based on subjective cognitive concerns. Participants with cognitive concerns ( = 35; 74.0 ± 9.6 years old, 62.9% female, 94.3% White) and without cognitive concerns ( = 33; 71.2 ± 7.1 years old, 75.8% female, 100% White) completed a neuropsychological battery of memory and executive function tests and underwent structural and resting-state magnetic resonance imaging, calculating frontoparietal network volume, thickness, and connectivity.
RESULTS
Participants with and without cognitive concerns had comparable numbers of low test scores (≤16th percentile), = .103, = .40. Participants with cognitive concerns had fewer high scores (≥75th percentile), = .004, = .71, and lower mean frontoparietal network volumes (left: = .004, = .74; right: = .011, = .66) and cortical thickness (left: = .010, = .66; right: = .033, = .54), but did not differ in network connectivity.
CONCLUSIONS
Among high-functioning older adults, subjective cognitive decline may correspond with an absence of high scores on neuropsychological testing and underlying changes in the frontoparietal network that would not be detected by a traditional focus on low cognitive test scores.
目的
神经心理学家难以检测出高功能老年人的认知衰退，因为在认知表现低到足以表明衰退或损伤之前，必须发生更显著的神经学变化。对于高功能老年人来说，早期神经学变化可能与主观认知问题以及缺乏高分有关。本研究比较了有和没有主观认知问题的高功能老年人，假设存在认知问题的老年人在神经心理学测试中的高分较少，额顶叶网络体积、厚度和连通性较低。
方法
参与者病前功能估计较高（例如，估计智力≥第75百分位数或受过大学教育），并根据主观认知问题进行分组。有认知问题的参与者（n = 35；74.0±9.6岁，62.9%为女性，94.3%为白人）和没有认知问题的参与者（n = 33；71.2±7.1岁，75.8%为女性，100%为白人）完成了一组记忆和执行功能的神经心理学测试，并接受了结构和静息态磁共振成像，计算额顶叶网络体积、厚度和连通性。
结果
有和没有认知问题的参与者低测试分数（≤第16百分位数）的数量相当，χ² = 0.103，p = 0.40。有认知问题的参与者高分（≥第75百分位数）较少，χ² = 0.004，p = 0.71，平均额顶叶网络体积较低（左侧：χ² = 0.004，p = 0.74；右侧：χ² = 0.011，p = 0.66）和皮质厚度较低（左侧：χ² = 0.010，p = 0.66；右侧：χ² = 0.033，p = 0.54），但在网络连通性方面没有差异。
结论
在高功能老年人中，主观认知衰退可能与神经心理学测试中缺乏高分以及额顶叶网络的潜在变化有关，而传统上关注低认知测试分数无法检测到这些变化。
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