UCSF, Memory and Aging Center, San Francisco, California, USA,
UCSF, Memory and Aging Center, San Francisco, California, USA.
Dement Geriatr Cogn Disord. 2024;53(3):119-127. doi: 10.1159/000538376. Epub 2024 Mar 21.
We comprehensively evaluated how self- and informant-reported neuropsychiatric symptoms (NPS) were differentially associated with cerebral amyloid-beta (Aβ) PET levels in older adults without dementia.
Two hundred and twenty-one participants (48% female, age = 73.4 years ± 8.4, Clinical Dementia Rating = 0 [n = 184] or 0.5 [n = 37]) underwent an Aβ-PET scan (florbetapir or PIB), comprehensive neuropsychological testing, and self-reported (Geriatric Depression Scale - 30 item [GDS-30]) and informant-reported interview (Neuropsychiatric Inventory Questionnaire [NPI-Q]) of NPS. Cerebral Aβ burden was quantified using centiloids (CL). NPI-Q and GDS-30 queried the presence of NPS within 4 subdomains and 6 subscales, respectively. Regression models examined the relationship between NPS and Aβ-PET CL.
Both higher self- and informant-reported NPS were associated with higher Aβ burden. Among specific NPI-Q subdomains, informant-reported changes in depression, anxiety, and irritability were all associated with higher Aβ-PET. Similarly, self-reported (GDS-30) subscales of depression, apathy, anxiety, and cognitive concern were associated with higher Aβ-PET. When simultaneously entered, only self-reported cognitive concern was associated with Aβ-PET in the GDS-30 model, while both informant-reported anxiety and depression were associated with Aβ-PET in the NPI-Q model. Clinical status moderated the association between self-reported NPS and Aβ-PET such that the positive relationship between self-perceived NPS and Aβ burden strengthened with increasing functional difficulties.
In a cohort of older adults without dementia, both self- and informant-reported measures of global NPS, particularly patient-reported cognitive concerns and informant-reported anxiety and depression, corresponded with cerebral Aβ burden. NPS may appear early in the prodromal disease state and relate to initial AD proteinopathy burden, a relationship further exaggerated in those with greater clinical severity.
我们全面评估了在无痴呆的老年人中，自我报告和知情者报告的神经精神症状（NPS）与大脑淀粉样蛋白-β（Aβ）PET 水平的差异相关性。
221 名参与者（48%为女性，年龄=73.4 岁±8.4，临床痴呆评定=0[n=184]或 0.5[n=37]）接受了 Aβ-PET 扫描（florbetapir 或 PIB）、全面的神经心理学测试以及自我报告（老年抑郁量表-30 项[GDS-30]）和知情者报告（神经精神问卷[NPI-Q]）的 NPS 评估。使用 centiloids（CL）量化脑内 Aβ负担。NPI-Q 和 GDS-30 分别询问了 4 个亚领域和 6 个亚量表中 NPS 的存在情况。回归模型检查了 NPS 与 Aβ-PET CL 之间的关系。
自我报告和知情者报告的 NPS 水平越高，与 Aβ 负担越相关。在特定的 NPI-Q 亚领域中，知情者报告的抑郁、焦虑和易怒变化均与 Aβ-PET 相关。同样，自我报告的（GDS-30）抑郁、淡漠、焦虑和认知担忧亚量表与 Aβ-PET 相关。当同时进入模型时，只有 GDS-30 模型中的自我报告的认知担忧与 Aβ-PET 相关，而 NPI-Q 模型中知情者报告的焦虑和抑郁均与 Aβ-PET 相关。临床状态调节了自我报告的 NPS 与 Aβ-PET 之间的关系，使得自我感知的 NPS 与 Aβ 负担之间的正相关关系随着功能障碍的增加而增强。
在一组无痴呆的老年人中，自我报告和知情者报告的整体 NPS 测量，特别是患者报告的认知问题以及知情者报告的焦虑和抑郁，与大脑 Aβ 负担相关。NPS 可能在疾病早期出现，并与 AD 蛋白病的初始负担相关，在临床症状更严重的患者中，这种关系进一步加剧。
