Appearance
Subjective cognitive decline and rates of incident Alzheimer's disease and non-Alzheimer's disease dementia.
文献信息
| DOI | 10.1016/j.jalz.2018.10.003 |
|---|---|
| PMID | 30555032 |
| 期刊 | Alzheimer's & dementia : the journal of the Alzheimer's Association |
| 影响因子 | 11.1 |
| JCR 分区 | Q1 |
| 发表年份 | 2019 |
| 被引次数 | 186 |
| 关键词 | 阿尔茨海默病, 路易体痴呆, 痴呆发生率, 额颞叶痴呆, 临床前阿尔茨海默病 |
| 文献类型 | Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S. |
| ISSN | 1552-5260 |
| 页码 | 465-476 |
| 期号 | 15(3) |
| 作者 | Rosalinde E R Slot, Sietske A M Sikkes, Johannes Berkhof, Henry Brodaty, Rachel Buckley, Enrica Cavedo, Efthimios Dardiotis, Francoise Guillo-Benarous, Harald Hampel, Nicole A Kochan, Simone Lista, Tobias Luck, Paul Maruff, José Luis Molinuevo, Johannes Kornhuber, Barry Reisberg, Steffi G Riedel-Heller, Shannon L Risacher, Susanne Roehr, Perminder S Sachdev, Nikolaos Scarmeas, Philip Scheltens, Melanie B Shulman, Andrew J Saykin, Sander C J Verfaillie, Pieter Jelle Visser, Stephanie J B Vos, Michael Wagner, Steffen Wolfsgruber, Frank Jessen, Wiesje M van der Flier |
一句话小结
这项多中心研究评估了主观认知下降（SCD）患者中阿尔茨海默病及非阿尔茨海默病痴呆的发生率及其决定因素，发现SCD患者的痴呆发生率显著高于对照组，尤其在记忆门诊环境中。研究表明，年龄、简易智力状态以及载脂蛋白E ε4基因型是痴呆风险的重要影响因素，提示SCD可作为痴呆的早期预警指标。
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阿尔茨海默病 · 路易体痴呆 · 痴呆发生率 · 额颞叶痴呆 · 临床前阿尔茨海默病
摘要
引言
在这项关于社区和记忆门诊环境中主观认知下降（SCD）的多中心研究中，我们评估了（1）阿尔茨海默病（AD）和非阿尔茨海默病痴呆的发生率，以及（2）进展至痴呆的决定因素。
方法
十一组研究提供了2978名具有SCD的参与者和1391名对照。我们使用Cox比例风险模型估算了痴呆发生率并识别了风险因素。
结果
在SCD患者中，痴呆的发生率为17.7（95%泊松置信区间15.2-20.3）/1000人年（AD: 11.5 [9.6-13.7]，非AD: 6.1 [4.7-7.7]），而对照组的发生率为14.2（11.3-17.6）（AD: 10.1 [7.7-13.0]，非AD: 4.1 [2.6-6.0]）。在记忆门诊环境中，SCD患者的痴呆风险显著增加，但在社区环境中则相对较低。此外，较高的年龄（风险比1.1 [95%置信区间1.1-1.1]）、较低的简易智力状态检查（0.7 [0.66-0.8]）和载脂蛋白E ε4（1.8 [1.3-2.5]）均增加了痴呆的风险。
讨论
SCD可以作为AD和非AD痴呆的前兆。尽管他们的年龄较小，但在记忆门诊环境中，SCD患者的痴呆风险高于社区人群中的个体。
英文摘要
INTRODUCTION In this multicenter study on subjective cognitive decline (SCD) in community-based and memory clinic settings, we assessed the (1) incidence of Alzheimer's disease (AD) and non-AD dementia and (2) determinants of progression to dementia.
METHODS Eleven cohorts provided 2978 participants with SCD and 1391 controls. We estimated dementia incidence and identified risk factors using Cox proportional hazards models.
RESULTS In SCD, incidence of dementia was 17.7 (95% Poisson confidence interval 15.2-20.3)/1000 person-years (AD: 11.5 [9.6-13.7], non-AD: 6.1 [4.7-7.7]), compared with 14.2 (11.3-17.6) in controls (AD: 10.1 [7.7-13.0], non-AD: 4.1 [2.6-6.0]). The risk of dementia was strongly increased in SCD in a memory clinic setting but less so in a community-based setting. In addition, higher age (hazard ratio 1.1 [95% confidence interval 1.1-1.1]), lower Mini-Mental State Examination (0.7 [0.66-0.8]), and apolipoprotein E ε4 (1.8 [1.3-2.5]) increased the risk of dementia.
DISCUSSION SCD can precede both AD and non-AD dementia. Despite their younger age, individuals with SCD in a memory clinic setting have a higher risk of dementia than those in community-based cohorts.
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主要研究问题
- 主观认知下降(SCD)的临床特征与其在阿尔茨海默病(AD)和非AD痴呆中的表现有什么区别？
- 在不同的社区基础和记忆诊所环境中，主观认知下降的风险因素是否存在显著差异？
- 如何评估主观认知下降与阿尔茨海默病和非阿尔茨海默病痴呆之间的因果关系？
- 在记忆诊所环境中，是否有特定的干预措施可以降低主观认知下降患者发展为痴呆的风险？
- 主观认知下降的患者在早期识别和干预方面的最佳实践是什么？
核心洞察
研究背景和目的
本研究旨在评估主观认知下降（SCD）与阿尔茨海默病（AD）及非AD类型痴呆的发生率，以及影响从SCD进展为痴呆的风险因素。研究表明，SCD可能是AD及其他类型痴呆的早期表现。
主要方法/材料/实验设计
本研究为多中心合作项目，包含来自11个队列的5521名参与者，其中2978名为SCD患者，1391名为对照组。研究通过Cox比例风险模型估算痴呆的发生率及其风险因素。以下是研究的技术路线图：
- 参与者招募：根据每个中心对SCD的定义招募参与者，SCD参与者需报告认知下降但认知评估结果正常。
- 数据收集：收集人口统计特征、认知功能（通过MMSE评估）、教育年限和APOE ε4基因型等信息。
- 统计分析：使用SPSS和Stata软件进行数据分析，评估SCD与痴呆的关联及风险因素。
关键结果和发现
- 在SCD组中，痴呆的发生率为17.7/1000人年（AD：11.5，非AD：6.1），对照组为14.2/1000人年（AD：10.1，非AD：4.1）。
- SCD患者在记忆诊所中的痴呆风险显著高于社区基础设置，且年龄（HR 1.1）、MMSE得分（HR 0.7）及APOE ε4基因型（HR 1.8）均为独立的风险因素。
- 在SCD患者中，约三分之一的痴呆病例为非AD类型，尤其在记忆诊所中，前额颞痴呆（FTD）和路易体痴呆（DLB）更为常见。
主要结论/意义/创新性
本研究表明，SCD不仅是AD的潜在前驱，还可能预示其他类型的痴呆。研究强调了SCD在痴呆早期筛查中的重要性，并揭示了不同招募设置对痴呆风险的影响。研究结果支持了针对SCD患者的早期干预策略。
研究局限性和未来方向
- 局限性：参与者的异质性较大，包括不同中心对SCD的定义、评估工具及诊断标准的差异，可能影响结果的普遍性。
- 未来方向：建议未来研究应纳入更多的生物标志物数据和多种认知测试，以进一步探讨SCD与痴呆之间的关系。同时，需加强对非AD类型痴呆的研究，以更全面理解SCD的临床意义。
| 研究要素 | 结果 |
|---|---|
| SCD痴呆发生率 | 17.7/1000人年（AD: 11.5，非AD: 6.1） |
| 对照组痴呆发生率 | 14.2/1000人年（AD: 10.1，非AD: 4.1） |
| 主要风险因素 | 年龄、MMSE得分、APOE ε4基因型 |
| 非AD痴呆比例 | SCD患者中约三分之一为非AD类型，记忆诊所中更为常见 |
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