阿尔茨海默病连续体中神经精神症状与营养状况之间的临床及神经影像学关联：一项纵向队列研究

Clinical and neuroimaging association between neuropsychiatric symptoms and nutritional status across the Alzheimer's disease continuum: a longitudinal cohort study.

作者信息

Jiang Jiwei, Wang Anxin, Shi Hanping, Jiang Shirui, Li Wenyi, Jiang Tianlin, Wang Linlin, Zhang Xiaoli, Sun Mengfan, Zhao Min, Zou Xinying, Xu Jun

机构信息

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.

Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China.

出版信息

J Nutr Health Aging. 2024 Mar;28(3):100182. doi: 10.1016/j.jnha.2024.100182. Epub 2024 Feb 9.

DOI:10.1016/j.jnha.2024.100182

PMID:38336502

Abstract

OBJECTIVES

To investigate the association between neuropsychiatric symptoms (NPS) and nutritional status, and explore their shared regulatory brain regions on the Alzheimer's disease (AD) continuum.

DESIGN

A longitudinal, observational cohort study.

SETTING

Data were collected from the Chinese Imaging, Biomarkers, and Lifestyle study between June 1, 2021 and December 31, 2022.

PARTICIPANTS

Overall, 432 patients on the AD continuum, including amnestic mild cognitive impairment and AD dementia, were assessed at baseline, and only 165 patients completed the (10.37 ± 6.08) months' follow-up.

MEASUREMENTS

The Mini-Nutritional Assessment (MNA) and Neuropsychiatric Inventory (NPI) were used to evaluate nutritional status and NPS, respectively. The corrected cerebral blood flow (cCBF) measured by pseudo-continuous arterial spin labeling of the dietary nutrition-related brain regions was analyzed. The association between the NPS at baseline and subsequent change in nutritional status and the association between the changes in the severity of NPS and nutritional status were examined using generalized linear mixed models.

RESULTS

Increased cCBF in the left putamen was associated with malnutrition, general NPS, affective symptoms, and hyperactivity (P < 0.05). The presence of general NPS (β = -1.317, P = 0.003), affective symptoms (β = -1.887, P < 0.001), and appetite/eating disorders (β = -1.714, P < 0.001) at baseline were associated with a decline in the MNA scores during follow-up. The higher scores of general NPI (β = -0.048), affective symptoms (β = -0.181), and appetite/eating disorders (β = -0.416; all P < 0.001) were longitudinally associated with lower MNA scores after adjusting for confounding factors.

CONCLUSIONS

We found that baseline NPS were predictors of a decline in nutritional status on the AD continuum. The worse the severity of affective symptoms and appetite/eating disorders, the poorer the nutritional status. Furthermore, abnormal perfusion of the putamen may regulate the association between malnutrition and NPS, which suggests their potentially common neural regulatory basis.

摘要

目的

研究神经精神症状（NPS）与营养状况之间的关联，并探索它们在阿尔茨海默病（AD）连续体上共同的调节脑区。

设计

一项纵向观察性队列研究。

设置

数据收集自2021年6月1日至2022年12月31日的中国影像、生物标志物和生活方式研究。

参与者

总体而言，432名处于AD连续体的患者，包括遗忘型轻度认知障碍和AD痴呆患者，在基线时接受了评估，只有165名患者完成了（10.37±6.08）个月的随访。

测量

分别使用微型营养评定法（MNA）和神经精神科问卷（NPI）评估营养状况和NPS。分析通过对饮食营养相关脑区进行伪连续动脉自旋标记测量的校正脑血流量（cCBF）。使用广义线性混合模型检查基线时的NPS与随后营养状况变化之间的关联，以及NPS严重程度变化与营养状况之间的关联。

结果

左侧壳核的cCBF增加与营养不良、一般NPS、情感症状和多动相关（P<0.05）。基线时存在一般NPS（β=-1.317，P=0.003）、情感症状（β=-1.887，P<0.001）和食欲/饮食障碍（β=-1.714，P<0.001）与随访期间MNA评分下降相关。在调整混杂因素后，一般NPI评分较高（β=-0.048）、情感症状评分较高（β=-0.181）和食欲/饮食障碍评分较高（β=-0.416；均P<0.001）与较低的MNA评分纵向相关。