Piccini C, Bracco L, Falcini M, Pracucci G, Amaducci L
Department of Neurological and Psychiatric Sciences, University of Florence, Policlinico di Careggi, Italy.
J Neurol Sci. 1995 Aug;131(2):177-82. doi: 10.1016/0022-510x(95)00107-d.
The aim of this 7-year inception cohort study was to determine the prognostic value of plateaux in cognitive decline in the course of Alzheimer's disease (AD) as well as their impact on the rate of progression of cognitive impairment. From a consecutive sample of 106 outpatients participating in a longitudinal study on AD, we selected 31 with a mild degree of mental deficit at presentation and a disease duration of at least 3 years when included into the study. All underwent extensive clinico-neuropsychological testing about every 6 months and there were no drop-outs. Mean period of follow-up lasted 6.8 (SD 2.9) years. Nineteen patients displayed a plateau, where a plateau refers to a patient's remaining on a mild level of cognitive decline for more than two years. Survival curves (Kaplan-Meier method) showed that patients with plateaux reached several end-points--very severe functional or cognitive impairment, urinary incontinence, death--significantly later than patients without (p < 0.04). Patients with plateaux showed a smaller cognitive loss (p < 0.01) in terms of the mean annual rate of progression of mental decline. In conclusion plateaux in an early stage of Alzheimer's Disease served to identify patients with a more favourable course.
这项为期7年的队列研究旨在确定阿尔茨海默病（AD）病程中认知衰退平台期的预后价值及其对认知障碍进展速度的影响。在106名参与AD纵向研究的连续门诊患者样本中，我们选取了31名在入组研究时存在轻度智力缺陷且病程至少3年的患者。所有患者大约每6个月接受一次全面的临床神经心理学测试，且无失访情况。平均随访期为6.8（标准差2.9）年。19名患者出现了平台期，这里的平台期是指患者在轻度认知衰退水平上持续超过两年。生存曲线（Kaplan-Meier法）显示，有平台期的患者达到几个终点——非常严重的功能或认知障碍、尿失禁、死亡——的时间明显晚于无平台期的患者（p < 0.04）。就精神衰退的年均进展率而言，有平台期的患者认知损失较小（p < 0.01）。总之，阿尔茨海默病早期的平台期有助于识别病程更有利的患者。
