不同的医疗和物质使用史与阿尔茨海默病的认知衰退相关。
Distinct medical and substance use histories associate with cognitive decline in Alzheimer's Disease.
作者信息
Mansel Clayton, Mazzotti Diego R, Townley Ryan, Sardiu Mihaela E, Swerdlow Russell H, Honea Robyn A, Veatch Olivia J
机构信息
Department of Cell Biology and Physiology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160.
Department of Internal Medicine, Division of Medical Informatics, Division of Pulmonary Critical Care and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS 66160.
出版信息
medRxiv. 2024 Nov 28:2024.11.26.24317918. doi: 10.1101/2024.11.26.24317918.
INTRODUCTION
Phenotype clustering reduces patient heterogeneity and could be useful when designing precision clinical trials. We hypothesized that the onset of early cognitive decline in patients would exhibit variance predicated on the clinical history documented prior to an Alzheimer's Disease (AD) diagnosis.
METHODS
Self-reported medical and substance use history (i.e., problem history) was used to cluster participants from the National Alzheimer's Coordinating Centers (NACC) into distinct subtypes. Linear mixed effects modeling was used to determine the effect of problem history subtype on cognitive decline over two years.
RESULTS
2754 individuals were partitioned into three subtypes: minimal (n = 1380), substance use (n = 1038), and cardiovascular (n = 336) subtypes. The cardiovascular problem history subtype had significantly worse cognitive decline over a two-year follow-up period (p = 0.013).
DISCUSSION
Our study highlights the need to account for problem history to reduce heterogeneity of outcomes in AD clinical trials.
引言
表型聚类可减少患者异质性，在设计精准临床试验时可能会有所帮助。我们假设，患者早期认知衰退的发作会表现出基于阿尔茨海默病（AD）诊断之前记录的临床病史的差异。
方法
使用自我报告的医疗和物质使用史（即问题病史）将来自国家阿尔茨海默病协调中心（NACC）的参与者聚类为不同的亚型。使用线性混合效应模型来确定问题病史亚型对两年内认知衰退的影响。
结果
2754名个体被分为三个亚型：最小型（n = 1380）、物质使用型（n = 1038）和心血管型（n = 336）。在两年的随访期内，心血管问题病史亚型的认知衰退明显更严重（p = 0.013）。
讨论
我们的研究强调了在AD临床试验中考虑问题病史以减少结果异质性的必要性。
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