Ryu Hui Jin, Kwon Kyoung Ja, Moon Yeonsil
Department of Neurology, Konkuk University Medical Center, Seoul, Korea.
Center for Geriatric Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, Korea.
Dement Neurocogn Disord. 2025 Jan;24(1):44-53. doi: 10.12779/dnd.2025.24.1.44. Epub 2025 Jan 7.
Recognizing cognitive decline patterns in mild cognitive impairment (MCI) is crucial for early screening and preventive interventions. However, studies on the trajectory of individual cognitive functions in MCI are limited. Thus, the purpose of this study was to identify subtypes and stages of cognitive decline in MCI using a machine learning method.
A total of 944 subjects consisting of those who were cognitively normal and those with MCI were enrolled. Fifteen neuropsychological tasks were used in the analysis. The optimal number of subtypes was determined based on the cross-validation information criterion. Fifteen stages of cognitive trajectory were estimated for each subtype.
The following three subtypes were identified: amnestic-verbal subtype, dysexecutive subtype, and amnestic-visual subtype. Of 723 (76.6%) subjects who had reached stage 1 at least, amnestic-verbal subtype accounted for the most (n=340, 47.0%), followed by dysexecutive subtype (n=253, 35.0%) and amnestic-visual subtype (n=130, 18%). The amnestic-verbal subtype had significantly more males (amnestic-verbal: 41.8%, dysexecutive: 31.2%, and amnestic-visual: 28.5%), younger subjects (amnestic-verbal: 72.01 years, dysexecutive: 74.43 years, and amnestic-visual: 75.06 years), higher educational years (amnestic-verbal: 11.06 years, dysexecutive: 9.53 years, and amnestic-visual: 9.79 years), lower Clinical Dementia Rating sum of boxes (amnestic-verbal: 1.40, dysexecutive: 1.61, and amnestic-visual: 1.71), and lower Korean-Instrumental Activities of Daily Living score (amnestic-verbal: 0.20, dysexecutive: 0.27, and amnestic-visual: 0.26).
Three types of MCIs were extracted using SuStaIn. Pathways of MCI deterioration could be different. The amnestic type could be bisected based on whether episodic verbal or visual memory is degraded first.
识别轻度认知障碍（MCI）中的认知衰退模式对于早期筛查和预防性干预至关重要。然而，关于MCI个体认知功能轨迹的研究有限。因此，本研究的目的是使用机器学习方法识别MCI中认知衰退的亚型和阶段。
共纳入944名受试者，包括认知正常者和MCI患者。分析中使用了15项神经心理学任务。根据交叉验证信息准则确定最佳亚型数量。为每个亚型估计了15个认知轨迹阶段。
识别出以下三种亚型：遗忘-语言亚型、执行功能障碍亚型和遗忘-视觉亚型。在至少达到1期的723名（76.6%）受试者中，遗忘-语言亚型占比最多（n = 340，47.0%），其次是执行功能障碍亚型（n = 253，35.0%）和遗忘-视觉亚型（n = 130，18%）。遗忘-语言亚型的男性比例显著更高（遗忘-语言型：41.8%，执行功能障碍型：31.2%，遗忘-视觉型：28.5%），受试者更年轻（遗忘-语言型：72.01岁，执行功能障碍型：74.43岁，遗忘-视觉型：75.06岁），受教育年限更高（遗忘-语言型：11.06年，执行功能障碍型：9.53年，遗忘-视觉型：9.79年），临床痴呆评定量表方框总和更低（遗忘-语言型：1.40，执行功能障碍型：1.61，遗忘-视觉型：1.71），韩国日常生活工具性活动评分更低（遗忘-语言型：0.20，执行功能障碍型：0.27，遗忘-视觉型：0.26）。
使用SuStaIn提取了三种类型的MCI。MCI恶化途径可能不同。遗忘型可根据情景性语言或视觉记忆是否首先衰退进行二分。
