Spampinato Maria Vittoria, Ulber Jenny L, Fayyaz Habiba, Sullivan Allison, Collins Heather R
Radiology and Radiological Science Department, Medical University of South Carolina, Charleston, SC, USA.
College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
J Alzheimers Dis. 2023;96(4):1827-1836. doi: 10.3233/JAD-220835.
Neuropsychiatric symptoms (NPS) carry an increased risk of progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD). There is a need to understand how to integrate NPS into the paradigm outlined in the 2018 NIA-AA Research Framework.
To evaluate a prediction model of MCI-AD progression using a collection of variables, including NPS, cognitive testing, apolipoprotein E4 status (APOE4), imaging and laboratory AD biomarkers.
Of 300 elderly subjects, 219 had stable MCI and 81 MCI-AD progression over a 5-year follow-up. NPS were measured using the Neuropsychiatric Inventory (NPI). A multivariate Cox Proportional Hazards Regression Analysis assessed the effects of APOE4, baseline NPI, baseline CSF amyloid-β, phosphorylated and total tau, baseline AD-signature MRI biomarker, baseline memory and executive function on MCI-AD progression.
27% progressed to dementia (median follow-up = 43 months). NPS were found in stable MCI (62.6%) and MCI-AD converters (70.3%). The Cox model exhibited a good fit (p < 0.001), and NPS (HR = 1.033, p = 0.027), phosphorylated tau (HR = 1.011, p = 0.025), total tau (HR = 1.005, p = 0.024), AD-signature MRI biomarker (HR = 0.111, p = 0.002), executive function (HR = 0.727, p = 0.045), and memory performance (HR = 0.387, p < 0.001) were significantly associated with dementia.
NPS may inform dementia risk assessment in conjunction with cognitive testing and imaging and laboratory AD biomarkers. NPS is independently associated with the risk of MCI-dementia progression, over and beyond the contributions of CSF biomarkers.
神经精神症状（NPS）会增加从轻度认知障碍（MCI）进展为阿尔茨海默病（AD）的风险。有必要了解如何将NPS纳入2018年美国国立衰老研究所-阿尔茨海默病协会（NIA-AA）研究框架所概述的范式中。
使用一系列变量评估MCI向AD进展的预测模型，这些变量包括NPS、认知测试、载脂蛋白E4状态（APOE4）、影像学和实验室AD生物标志物。
在300名老年受试者中，219人在5年随访期间MCI稳定，81人出现MCI向AD的进展。使用神经精神量表（NPI）测量NPS。多变量Cox比例风险回归分析评估了APOE4、基线NPI、基线脑脊液淀粉样蛋白-β、磷酸化和总tau蛋白、基线AD特征性MRI生物标志物、基线记忆和执行功能对MCI向AD进展的影响。
27%的患者进展为痴呆（中位随访时间 = 43个月）。在MCI稳定患者（62.6%）和MCI向AD转化患者（70.3%）中均发现了NPS。Cox模型拟合良好（p < 0.001），NPS（风险比[HR] = 1.033，p = 0.027）、磷酸化tau蛋白（HR = 1.011，p = 0.025）、总tau蛋白（HR = 1.005，p = 0.024）、AD特征性MRI生物标志物（HR = 0.111，p = 0.002）、执行功能（HR = 0.727，p = 0.045）和记忆表现（HR = 0.387，p < 0.001）与痴呆显著相关。
NPS可能与认知测试、影像学和实验室AD生物标志物一起为痴呆风险评估提供信息。NPS与MCI向痴呆进展的风险独立相关，超出了脑脊液生物标志物的作用。
