Zhu Carolyn W, Schneider Lon S, Soleimani Laili, Neugroschl Judith, Grossman Hillel T, Schimming Corbett, Sano Mary
Brookdale Department of Geriatrics and Palliative Medicine (Zhu) and Alzheimer's Disease Research Center, Department of Psychiatry (Zhu, Soleimani, Neugroschl, Grossman, Schimming, Sano), Icahn School of Medicine at Mount Sinai, New York City; James J. Peters Department of Veterans Affairs Medical Center, New York City (Grossman, Schimming, Sano); Department of Psychiatry, Neurology, and Gerontology, Keck School of Medicine and Leonard Davis School of Gerontology, University of Southern California, Los Angeles (Schneider).
J Neuropsychiatry Clin Neurosci. 2025 Jun 26:appineuropsych20250015. doi: 10.1176/appi.neuropsych.20250015.
The authors explored classes of neuropsychiatric symptoms (NPSs) in Alzheimer's disease (AD), examined the relationship between NPS classes on rate of functional decline over time, and determined whether effects of individual symptoms on functional decline remained after controlling for NPS classes.
The authors longitudinally analyzed 9,797 study participants with mild cognitive impairment or AD at baseline in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured with the Functional Assessment Questionnaire, and NPSs were assessed by using clinician judgment. Latent class analysis (LCA) was used to identify clusters of individuals who shared similar NPS profiles. Linear mixed models were used to estimate the relationship between NPS classes and individual symptom profiles in functional decline over time.
LCA revealed four distinct NPS classes: an asymptomatic-mild group (48.2% of the sample, N=4,721), a second group predominantly having apathy and depression (36.4%, N=3,562), a third group with high rates of multiple symptoms except for hallucinations (12.8%, N=1,250), and a small group with high rates of all symptoms (complex class, 2.7%, N=264). NPS classes differed in baseline function but were not significantly associated with rate of functional decline. When NPS classes were controlled for, persistent apathy remained strongly associated with a faster rate of functional decline. Effects of apathy were observed across NPS classes and disease severity levels.
Specific symptoms rather than classes of symptoms were associated with the trajectory of functional decline in AD. Apathy may be particularly useful for tracking longitudinal changes in function.
作者探究了阿尔茨海默病（AD）中的神经精神症状（NPSs）类别，研究了NPS类别与功能随时间下降速率之间的关系，并确定在控制NPS类别后，个体症状对功能下降的影响是否依然存在。
作者对国家阿尔茨海默病协调中心统一数据集中9797名基线时患有轻度认知障碍或AD的研究参与者进行了纵向分析。功能通过功能评估问卷进行测量，NPSs由临床医生判断评估。潜在类别分析（LCA）用于识别具有相似NPS特征的个体集群。线性混合模型用于估计NPS类别与功能随时间下降过程中个体症状特征之间的关系。
LCA揭示了四个不同的NPS类别：无症状 - 轻度组（占样本的48.2%，N = 4721），第二组主要表现为淡漠和抑郁（36.4%，N = 3562），第三组除幻觉外多种症状发生率高（12.8%，N = 1250），以及一小组所有症状发生率高的复杂类别（2.7%，N = 264）。NPS类别在基线功能方面存在差异，但与功能下降速率无显著关联。在控制NPS类别后，持续性淡漠仍与更快的功能下降速率密切相关。在所有NPS类别和疾病严重程度水平上均观察到淡漠的影响。
在AD中，与功能下降轨迹相关的是特定症状而非症状类别。淡漠可能对追踪功能的纵向变化特别有用。
