两种遗忘型轻度认知损害患者的随访比较

目的 比较单纯遗忘型轻度认知功能损害(aMCI-s)和多个认知领域损害遗忘型轻度认知功能损害(aMCI-m)患者的2年随访转归结果并分析其神经心理学变化.方法 采用MMSE、听觉词语学习测验(AVLT)、逻辑回忆测验(LMT)、连线测验(TMT)、Stroop色词测验(CWT)、Rey复杂图形测验(CFT)、五点连线测验(FPT)、画钟测验(CDT)、言语流畅性测验(VF)和临床痴呆量表(CDR)等一系列神经心理测验评估记忆障碍门诊130例遗忘型轻度认知功能损害(aMCI)就诊者(其中aMCI-s 66例和aMCI-m 64例),并进行平均2年的随访,MCI及AD的诊断标准分别参照美国Petersen等及美国神经病学、语言障碍和卒中-老年性痴呆和相关疾病学会(NINCDS-ADRDA)有关诊断标准.结果 aMCI的阿尔茨海默病(AD)总转化率为33.8%(44/130);aMCI-s和aMCI-m的AD转化率分别为26.2%(17/65)和42.9%(27/63),差异有统计学意义(x2=3.957,P=0.047).随着aMCI发展为AD,aMCI-s和aMCI-m组在记忆和执行功能方面的减退幅度接近,aMCI-s组的视空间结构能力相对保留,语言和注意力的减退更快,aMCI-m组的视空间结构能力衰退更为显著.结论 aMCI-m比aMCI-s更容易发展为AD,aMCI分为aMCI-s和aMCI-m对判断认知功能减退的速度是有必要的,有助于判断预后.

Longitudinal study of two subtypes of mild cognitive impairment

Objective To investigate the conversion rate of subtypes of amnestic mild cognitive impairment (aMCI) to Alzheimer' s disease (AD) and assess the contribution of neuropsychological disturbance in progression from MCI to AD over 2 years. Method Subjects from memory clinic of Huashan hospital including 130 of who met the operational criteria for Mayo Clinic defined aMCI by neuropsychological tests covering global cognitive function, executive function, memory function, language function and visual spatial skills. They underwent multidimensional assessment and a neuropsychological battery at baseline and at follow-up, after about 2 years. Diagnosis for dementia was based on National Institute of Neurological and Communicative Disorders and Stroke; Alzheimer' s Disease and Related Disorders Association (NINCDS-ADRDA) criteria. Results Forty-four cases of 130 (33. 8% ) elder people with aMCI converted to probable AD with 17 aMCI-s and 27 aMCI-m subjects within an average 23.8 (6. 8 ) months. There was significant difference between the reversion rate of aMCI-s and aMCI-m (26. 2% vs 42. 9%, x2 = 3.957,P = 0. 047). Moreover, as the disease progressing,the two groups declined similarly in memory and executive function while in the aMCI-s group, the function of spatial structure relatively reserved in aMCI-s but function of language and attention diminished faster, and in the aMCI-m group, the ability of spatial structure declined even more significantly. Conclusion The aMCI-m is more likely to progress to AD than aMCI-s and it' s necessary to divide aMCI into aMCI-s and aMCI-m to help determine prognosis.