Department of Psychiatry and Behavioral Sciences (JSS), Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Psychiatry and Behavioral Sciences (JML, PBR), Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD.
Am J Geriatr Psychiatry. 2024 Jun;32(6):754-764. doi: 10.1016/j.jagp.2024.01.015. Epub 2024 Jan 17.
Although dementia is typically considered a disease of cognitive decline, almost all patients present with neuropsychiatric symptoms (NPS) at some stage of their disease. Few studies have assessed the timing of NPS onset in relation to pathological diagnoses of neurodegenerative diseases. We sought to examine the association between the first presenting clinically significant NPS in aging individuals and neuropathological diagnoses of memory disorders.
This retrospective longitudinal cohort study utilized the National Alzheimer's Coordinating Center (NACC) dataset, which includes participant data from 37 Alzheimer's Disease Research Centers collected between 2005 and 2022.
Participants (N = 5,416) aged 45 years or older with Clinical Dementia Rating-Global ratings of less than or equal to 1 were included in this analysis. A total of 4,033 (74.5%) participants presented with at least one NPS at any NACC visit.
To measure first NPS, the NACCBEHF variable was used, a clinician-rated variable defined as "the predominant symptom that was first recognized as a decline in the subject's behavior." Neuropathologic variables included assessments of Alzheimer's Disease, Frontotemporal Dementia, Lewy Body Dementia, Cerebral Amyloid Angiopathy, Hippocampal Sclerosis, and Cerebrovascular Disease.
Presentation with any clinically significant first NPS was associated with several neuropathological diagnoses including Alzheimer's Disease, Frontotemporal Lobar Dementia with TDP-43 pathology, and Lewy Body Dementia. While specific first NPS were associated with Frontotemporal Dementia neuropathology (personality change and disinhibition) and Lewy Body Dementia neuropathology (psychosis and REM behavior disturbance), Alzheimer's Disease neuropathology was associated with the majority of NPS.
Since neuropsychiatric symptoms are frequently the first presenting symptom of dementia, their associations with well-defined neuropathological diagnoses may help clinicians predict the subtype of future dementias.
尽管痴呆症通常被认为是一种认知能力下降的疾病，但几乎所有患者在疾病的某个阶段都会出现神经精神症状 (NPS)。很少有研究评估 NPS 发病与神经退行性疾病病理诊断之间的时间关系。我们试图研究在衰老个体中首次出现具有临床意义的 NPS 与记忆障碍的神经病理学诊断之间的关联。
这项回顾性纵向队列研究利用了国家阿尔茨海默病协调中心 (NACC) 数据集，该数据集包含了 2005 年至 2022 年期间来自 37 个阿尔茨海默病研究中心的参与者数据。
本分析纳入了年龄在 45 岁或以上、临床痴呆评定量表-全球评分≤1 的参与者 (N=5416)。共有 4033 名 (74.5%) 参与者在任何 NACC 就诊时至少出现过一种 NPS。
为了测量首次 NPS，使用了 NACCBEHF 变量，这是一个临床医生评定的变量，定义为“首先被识别为受试者行为下降的主要症状”。神经病理学变量包括阿尔茨海默病、额颞叶痴呆、路易体痴呆、脑淀粉样血管病、海马硬化和脑血管疾病的评估。
出现任何具有临床意义的首次 NPS 与包括阿尔茨海默病、TDP-43 病理相关的额颞叶痴呆和路易体痴呆在内的几种神经病理学诊断相关。虽然特定的首次 NPS 与额颞叶痴呆神经病理学相关 (人格改变和失抑制) 和路易体痴呆神经病理学相关 (精神病和 REM 行为障碍)，但阿尔茨海默病神经病理学与大多数 NPS 相关。
由于神经精神症状通常是痴呆症的首发症状，它们与明确的神经病理学诊断的关联可能有助于临床医生预测未来痴呆症的亚型。
