摘要
背景:阿尔茨海默病(AD)可以被概念化为一个连续体:患者由于AD而从正常认知发展到轻度认知障碍(MCI),随后AD的严重程度也随之增加。埃米提亚。先前的研究已经测量了AD晚期之间的转换概率,但没有对整个光谱进行测量。目的:估计AD连续体和e期的年进展率。评估AD所致MCI的延迟对AD痴呆的发展轨迹和临床预后的影响。 方法:采用国家阿尔茨海默氏病协调中心的病人水平纵向数据(n=18),对103例65岁以上多次就诊的患者进行年度年龄统计分析。正常认知、AD所致MCI与AD严重程度之间的相关性(由临床痴呆评分确定)。多变量模型预测死亡概率和研究所每个健康状态的nalization,条件是年龄和时间从上一次评估。这些概率用于填充描述进展到特定的疾病状态或死亡,以任何给定的当前状态和年龄。最后,建立了一个健康状态模型,以估计降低从常模过渡的风险的预期效果。对65岁年龄组患者在35年时间范围内的疾病进展率的认知。 结果:年龄65岁及65岁以上的轻度/中度/重度AD分别为8%、22%、25%、36%和16%,65岁以下为轻度/中度/重度AD作为年龄的函数。 由于AD,从正常认知到MCI的进展率每年为4%至10%。 认知损害和年龄的严重程度均增加了制度化的可能性。死亡和死亡。对于年龄在65岁时认知能力正常的100名患者来说,AD导致的MCI年进展率减少20%,避免了因AD和AD所致的MCI 5.7例和5.6例。是的。这种减少导致在严重AD痴呆健康状态下花费的时间减少,并被制度化,并延长了预期寿命。 结论:通过AD严重程度状态的正常认知转变概率对于了解AD患者的进展具有重要意义。这些估计可用于评估。e减少因AD而导致的MCI的进展对终生健康结果的影响。
关键词: 轻度认知障碍,路易体,载脂蛋白E,痴呆,老年痴呆症,衰老。
Current Alzheimer Research
Title:Estimating Alzheimer’s Disease Progression Rates from Normal Cognition Through Mild Cognitive Impairment and Stages of Dementia
Volume: 15 Issue: 8
关键词: 轻度认知障碍,路易体,载脂蛋白E,痴呆,老年痴呆症,衰老。
摘要: Background: Alzheimer’s Disease (AD) can be conceptualized as a continuum: patients progress from normal cognition to mild cognitive impairment (MCI) due to AD, followed by increasing severity of AD dementia. Prior research has measured transition probabilities among later stages of AD, but not for the complete spectrum.
Objective: To estimate annual progression rates across the AD continuum and evaluate the impact of a delay in MCI due to AD on the trajectory of AD dementia and clinical outcomes.
Methods: Patient-level longitudinal data from the National Alzheimer’s Coordinating Center for n=18,103 patients with multiple visits over the age of 65 were used to estimate annual, age-specific transitional probabilities between normal cognition, MCI due to AD, and AD severity states (defined by Clinical Dementia Rating score). Multivariate models predicted the likelihood of death and institutionalization for each health state, conditional on age and time from the previous evaluation. These probabilities were used to populate a transition matrix describing the likelihood of progressing to a particular disease state or death for any given current state and age. Finally, a health state model was developed to estimate the expected effect of a reduction in the risk of transitioning from normal cognition to MCI due to AD on disease progression rates for a cohort of 65-year-old patients over a 35-year time horizon.
Results: Annual transition probabilities to more severe states were 8%, 22%, 25%, 36%, and 16% for normal cognition, MCI due to AD, and mild/moderate/severe AD, respectively, at age 65, and increased as a function of age. Progression rates from normal cognition to MCI due to AD ranged from 4% to 10% annually. Severity of cognitive impairment and age both increased the likelihood of institutionalization and death. For a cohort of 100 patients with normal cognition at age 65, a 20% reduction in the annual progression rate to MCI due to AD avoided 5.7 and 5.6 cases of MCI due to AD and AD, respectively. This reduction led to less time spent in severe AD dementia health states and institutionalized, and increased life expectancy.
Conclusion: Transition probabilities from normal cognition through AD severity states are important for understanding patient progression across the AD spectrum. These estimates can be used to evaluate the clinical benefits of reducing progression from normal cognition to MCI due to AD on lifetime health outcomes.
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Estimating Alzheimer’s Disease Progression Rates from Normal Cognition Through Mild Cognitive Impairment and Stages of Dementia, Current Alzheimer Research 2018; 15 (8) . https://dx.doi.org/10.2174/1567205015666180119092427
DOI https://dx.doi.org/10.2174/1567205015666180119092427 |
Print ISSN 1567-2050 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-5828 |
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Neuroinflammation is an invariable hallmark of chronic and acute neurodegenerative disorders and has long been considered a potential drug target for Alzheimer?s disease (AD) and dementia. Significant evidence of inflammatory processes as a feature of AD is provided by the presence of inflammatory markers in plasma, CSF and postmortem brain ...read more
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