早发型阿尔茨海默病危险因素和认知损害特点分析

Analysis of risk factors and cognitive impairment characteristics of early-onset Alzheimer's disease

目的 分析早发型阿尔茨海默病的危险因素和认知损害特点,为其早期识别和预防提供理论依据。方法 选取2018年9月至2021年3月安徽省立医院神经内科收治的阿尔茨海默病患者69例,依据年龄是否≤65岁分为早发型阿尔茨海默病42例和晚发型阿尔茨海默病27例,选取同时期就诊的认知正常对照组31例,比较EOAD组和对照组的临床资料,采用二元logistic回归分析确定EOAD发病的危险因素,同时比较EOAD组和LOAD组患者不同认知域得分差异,探寻EOAD的认知损害特点。结果 与对照组相比,EOAD组有痴呆家族史者、ApoE4等位基因阳性者增多(P <0.05),且高密度脂蛋白胆固醇为(1.34±0.35)mmol/L,高于对照组的(1.12±0.29)mmol/L(P<0.05),维生素B_(12)为(259.40±121.75)pg/ml,低于对照组的(404.34±248.36)pg/ml(P<0.05);二元logistic回归分析发现低BMI、低维生素B_(12)、APOE4携带是EOAD发病的独立危险因素(P<0.05);与LOAD患者相比,EOAD患者的抽象思维强于LOAD患者(P<0.05),而计算力损伤较LOAD患者明显(P<0.05)。结论 EOAD计算力损害较LOAD明显,APOE4等位基因携带、低BMI和维生素B_(12)缺乏是EOAD的危险因素,重视痴呆家族史和APOE基因型的筛查,进行营养调查、补充维生素B12可能有助于预防EOAD。

Objective To analyze the risk factors and cognitive impairment characteristics of early-onset Alzheimer's disease,and to provide a theoretical basis for early identification and prevention.Methods A total of 69 patients with Alzheimer's disease admitted to the Department of Neurology of Anhui Provincial Hospital from September 2018 to March 2021 were selected.According to whether the age was≤65 years old,they were divided into the EOAD group and the LOAD group,with 42 and 27 patients,respectively.A total of 31 patients with normal cognitive function treated in the hospital during the same period were selected as the control group.The clinical data were compared between the EOAD group and the control group,and binary logistic regression analysis was conducted to determine the risk factors of EOAD.The different cognitive domain scores were compared between the EOAD group and the LOAD group,to explore the cognitive impairment characteristics of EOAD.Results Compared with the control group,the number of patients with family history of dementia and ApoE4 allele positive in the EOAD group was increased(P<0.05).The high-density lipoprotein cholesterol level in the EOAD group(1.34±0.35)mmol/L was significantly increased than that in the control group(1.12±0.29)mmol/L(P<0.05).The vitamin B_(12) level in the EOAD group(259.40±121.75)pg/ml was lower than that in the control group(404.34±248.36)pg/ml(P<0.05).The binary logistic regression analysis showed that low BMI,vitamin B_(12) deficiency,and APOE4 carrying were independent risk factors for the onset of EOAD(P<0.05).Compared with LOAD patients,EOAD patients had stronger abstract thinking(P<0.05),and more significant computational impairment than LOAD patients(P<0.05).Conclusion EOAD patients have more significant computational impairment than LOAD patients.APOE4 allele carrying,low BMI,and vitamin B_(12) deficiency are risk factors for EOAD.Paying attention to family history of dementia and APOE genotype screening,nutrition investigation and vitamin B_(12) supplementation may help prevent EOAD.