遗忘型轻度认知功能损害认知特征的随访研究

Cognitive changes in amnestic mild cognitive impairment：a follow-up study

目的 探讨遗忘型轻度认知功能损害（aMCI）的转归及其认知特征的变化.方法 横断面病例-对照和队列研究.采用多维度神经心理测试评估109例aMCI患者和104例正常对照者的神经认知功能.结果 与正常对照组相比,aMCI组的各项神经认知功能基线测试成绩均显著下降（均P＜0.01）,尤以反映情节记忆的听觉词语记忆测试（AVMT）的20min延迟回忆受损最明显[aMCI组（2.50±1.48）分,正常对照组（7.85±1.59）分,Z=-12.697,P＜0.01];随访期间69例aMCI患者有15例转变为AD,转化率22%,而正常组无转变为AD者;随访期间aMCI组患者的AVMT、CDT及MMSE测试成绩的减分率[分别为（3.77±60.83）%,（6.89±28.24）%,（6.13±16.89）%]低于正常对照组[分别为（-10.75±27.46）%,（-5.23±14.05）%,（-1.11±8.26）%],差异具有显著性（均P＜0.05）;将aMCI组分为认知功能稳定组及转变为AD组,比较2组之间神经认知功能基线测试成绩,差异有统计学意义的测验有AVMT、CFT、TMT-A、TMT-B、SDMT、CDT及MMSE;进一步比较2组之间测试成绩的减分率,aMCI组中转变为AD者AVMT、CFT、DST、VFT、SDMT、MMSE显著下降,差异具有显著性（均P＜0.05）.结论 aMCI是AD的前驱期;aMCI患者存在明显的情节记忆减退;神经心理测试有助于预测aMCI是否发展为AD.

Objective To investigate outcome and cognitive changes of amnestic mild cognitive impairment （aMCI） in a follow-up study. Methods A cross-sectional and longitudinal parallel cohort study design was conducted among 109 aMCI patients and 104 matched normal controls. Multi-dimension neuropsychologic tests were used to extensively assess the cognitive function. Results The scores of neuropsychologic tests in aMCI patients were significantly lower than those in the normal controls（ all P＜0.01 ） ,with the largest impairment on 20minutes delayed recall of the auditory verbal memory test （ AVMT）, which reflects episodic memory （ aMCI pa-tients ：2.50 ± 1.48, normal controls ：7.85 ± 1.59, Z = - 12.697, P ＜ 0.01 ）; AD was diagnosed in 15 of the 69aMCI patients with a prevalence rate of 22% ,but none was converted to AD in the normal controls. The cognitivechanges of performance in AVMT, CDT, MMSE of the patients in aMCI group （（ 3.77 ± 60.83 ）%, （6.89 ±28.24） %, （6.13 ± 16.89） % respectively） were significantly poorer than those of the controls group（（ - 10.75 ±27.46） %, （ - 5.23 ± 14.05 ） %, （ - 1.11 ± 8.26 ） % respectively） （ all P ＜ 0.05 ）. At baseline, demented aMCIperformed poorer in AVMT, CFT, TMT, SDMT, CDT, MMSE when compared to stable. During the follow-up, demented aMCI groups performed significantly poorer than did stable subjects in AVMT, CFT, DST, VFT, SDMT,MMSE （ all P ＜ 0.05 ）. Conclusion aMCI is a prodromal period of AD and characterized by episodic memory impairment. The neuropsychologic test is a predictive factor for aMCI to develop AD.