Li Wenyi, Jiang Jiwei, Ren Qiwei, Zhao Min, Wang Linlin, Yang Shiyi, Jiang Shirui, Jiang Tianlin, Zhang Huiying, Xu Jun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center For Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Brain Behav. 2025 Aug;15(8):e70719. doi: 10.1002/brb3.70719.
Subjective cognitive decline (SCD) is a preclinical stage of Alzheimer's disease (AD). However, the factors influencing SCD progression remain unclear. It is necessary to develop a model for predicting cognitive progression in SCD.
96 participants with SCD and 36 healthy controls (HCs) were enrolled from the Chinese Imaging, Biomarkers, and Lifestyle study between January 1 and June 30, 2022. Of these, 70 completed approximately 12 months of follow-up visits. Clinical, cognitive assessment, and neuroimaging data were collected. Cox proportional-hazard regression models were used to investigate the risk factors and construct a nomogram.
Compared to HCs, participants with SCD had higher Pittsburgh Sleep Quality Index (PSQI) scores, indicating they had poorer sleep quality, and had higher cerebral blood flow (CBF) in bilateral hippocampus, thalamus, and left precuneus (all p < 0.05). Poorer sleep quality and left precuneus CBF were independently associated with SCD progression (all p < 0.05). The nomogram constructed with these factors achieved good discriminative ability, with an AUC of 0.785 (95% CI: 0.609-0.960) and a coherence index of 0.840 (95% CI: 0.733-0.948). The calibration curves showed significant agreement between the model and actual observations, and the decision curve analysis of the model showed clinical benefit.
A predictive model for SCD progression constructed based on risk factors including PSQI scores and left precuneus CBF showed good accuracy and discrimination ability, and it may provide valuable insights for early stage screening of AD.
主观认知下降（SCD）是阿尔茨海默病（AD）的临床前期阶段。然而，影响SCD进展的因素仍不清楚。有必要建立一个预测SCD认知进展的模型。
2022年1月1日至6月30日期间，从中国影像、生物标志物和生活方式研究中招募了96名SCD参与者和36名健康对照者（HCs）。其中，70人完成了约12个月的随访。收集了临床、认知评估和神经影像学数据。采用Cox比例风险回归模型研究危险因素并构建列线图。
与HCs相比，SCD参与者的匹兹堡睡眠质量指数（PSQI）得分更高，表明他们的睡眠质量较差，双侧海马、丘脑和左侧楔前叶的脑血流量（CBF）更高（所有p<0.05）。较差的睡眠质量和左侧楔前叶CBF与SCD进展独立相关（所有p<0.05）。用这些因素构建的列线图具有良好的判别能力，AUC为0.785（95%CI：0.609 - 0.960），一致性指数为0.840（95%CI：0.733 - 0.948）。校准曲线显示模型与实际观察结果之间有显著一致性，模型的决策曲线分析显示具有临床益处。
基于PSQI得分和左侧楔前叶CBF等危险因素构建的SCD进展预测模型显示出良好的准确性和判别能力，可能为AD的早期筛查提供有价值的见解。
