Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA.
Charles F. and Joanne Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
Alzheimers Dement. 2024 Mar;20(3):2080-2088. doi: 10.1002/alz.13679. Epub 2024 Jan 15.
Reversion, or change in cognitive status from impaired to normal, is common in aging and dementia studies, but it remains unclear what factors predict reversion.
We investigated whether reverters, defined as those who revert from a Clinical Dementia Rating® (CDR®) scale score of 0.5 to CDR 0) differed on cognition and biomarkers from unimpaired participants (always CDR 0) and impaired participants (converted to CDR > 0 and had no reversion events). Models evaluated relationships between biomarker status, apolipoprotein E (APOE) ε4 status, and cognition. Additional models described predictors of reversion and predictors of eventual progression to CDR > 0.
CDR reversion was associated with younger age, better cognition, and negative amyloid biomarker status. Reverters that eventually progressed to CDR > 0 had more visits, were older, and were more likely to have an APOE ε4 allele.
CDR reversion occupies a transitional phase in disease progression between cognitive normality and overt dementia. Reverters may be ideal candidates for secondary prevention Alzheimer's disease (AD) trials.
Reverters had more longitudinal cognitive decline than those who remained cognitively normal. Predictors of reversion: younger age, better cognition, and negative amyloid biomarker status. Reverting from CDR 0.5 to 0 is a risk factor for future conversion to CDR > 0. CDR reversion may be a transitional phase in Alzheimer's Disease progression. CDR reverters may be ideal for Alzheimer's disease secondary prevention trials.
在衰老和痴呆症研究中，认知状态从受损恢复正常（即逆转）较为常见，但目前尚不清楚哪些因素可预测逆转。
我们研究了从临床痴呆评定量表（CDR）评分 0.5 逆转到 CDR 0 的逆转者（定义为 CDR 0）与认知功能正常者（始终为 CDR 0）和认知障碍者（转换为 CDR>0 且无逆转事件）之间是否存在差异。模型评估了生物标志物状态、载脂蛋白 E（APOE）ε4 状态与认知之间的关系。其他模型描述了逆转的预测因素和最终进展为 CDR>0 的预测因素。
CDR 逆转与年龄较小、认知功能较好和阴性淀粉样蛋白生物标志物状态有关。最终进展为 CDR>0 的逆转者就诊次数更多、年龄更大，且更有可能携带 APOE ε4 等位基因。
CDR 逆转处于认知正常与明显痴呆之间的疾病进展的过渡阶段。逆转者可能是阿尔茨海默病（AD）二级预防临床试验的理想候选者。
与认知正常者相比，发生逆转者的纵向认知衰退更多。逆转的预测因素：年龄较小、认知功能较好和阴性淀粉样蛋白生物标志物状态。从 CDR 0.5 逆转到 0 是未来转为 CDR>0 的危险因素。CDR 逆转可能是 AD 进展的过渡阶段。CDR 逆转者可能是 AD 二级预防试验的理想选择。
