Neuropsychiatric Symptoms in Different Subtypes of Mild Cognitive Impairment

背景：輕度認知障礙被認為是一種介於正常老化與失智之間的過渡階段。根據被影響的認知區域及數目可分類為不同的亞型。神經精神症狀在失智及輕度認知障礙病患的表現過去已被廣泛討論，但目前對於其在輕度認知障礙亞型的表現相關文獻仍顯不足。本篇研究即探討神經精神症狀在此疾病不同亞型之盛行率。方法：本橫斷面研究於2007至2011年在台灣的兩間醫院門診收案，所有參與者均接受基本的評估及診斷，包括醫療病史、身體檢查、神經學及神經心理評估。個案根據訂定的診斷標準被分類為不同的亞型，包括失憶型、非失憶型、單純型及多面向型。神經精神症狀則使用神經精神量表中文版評估，分別比較失憶型和非失憶型，單純型和多面向型之間各種神經精神症狀之盛行率及其分數。結果：本研究總共納入159位輕度認知障礙個案，其中99位(62.3%)為失憶型，60位(37.7%)為非失憶型，75位(47.2%)為單純型，84位(52.8%)為多面向型輕度認知障礙。與失憶型相比，非失憶型有較高的焦慮盛行率及症狀分數，但經年齡、性別，教育及認知功能分數控制後則無顯著差異。多面向型比單純型較可能有至少一種神經精神症狀(63.1% vs. 45.3%, p=0.027)，較高的冷漠盛行率(26.2% vs. 13.3%, p=0.049)及症狀分數。在控制共變項後，多面向型與至少一種神經精神症狀的表現仍有顯著相關(p=0.042)。結論：跟單純型輕度認知障礙比較起來，多面向型和較高的神經精神症狀之盛行率相關。後續仍需更多的研究了解神經精神症狀在不同亞型的盛行率及其病理生理學。

關鍵字

輕度認知障礙；神經精神症狀；冷漠；焦慮

並列摘要

Background: Mild cognitive impairment (MCI) is considered to be an intermediate cognitive state between the normal cognitive aging and dementia. Different MCI subtypes are classified by the number and characteristics of the affected cognitive domains. Neuropsychiatric symptoms (NPS) in dementia and MCI have been extensively studied, but little is known about its prevalence in MCI subtypes. In this study, we aimed to investigate NPS in different MCI subtypes. Methods: In this cross-sectional study, a total of 159 MCI subjects were recruited from the outpatient clinics of two hospitals in Taiwan from 2007-2011. All participants received baseline diagnostic evaluations, including medical history, physical examinations, neurologic and neuropsychological assessments. MCI patients were classified into different subtypes, including amnestic (aMCI), non-amnestic (non-aMCI), single-domain MCI, and multiple-domain MCI. The Neuropsychiatric Inventory was used to assess NPS. The prevalence and score of each neuropsychiatric symptom were compared between aMCI and non-aMCI, and between single-domain and multiple-domain MCI subtypes. Results: Of the 159 subjects with MCI, 99 (62.3%) met the criteria for aMCI, 60 (37.7%) for non-aMCI, 75 (47.2%) for single-domain MCI, and 84 (52.8%) for multiple-domain MCI. The non-aMCI group was associated with more prevalent anxiety and a higher anxiety score than the aMCI group. The difference became insignificant after controlling for age, sex, education and MMSE. When compared with the single-domain MCI group, the multiple-domain MCI group was more likely to have at least one NPS (63.1% vs. 45.3%, p=0.027), more prevalent apathy (26.2% vs. 13.3%, p=0.049), and a higher apathy score. After controlling for covariates, multiple-domainMCI group was still more likely to have at least one NPS (p=0.042). Conclusions: Our findings suggest that multiple-domain MCI is associated with more prevalent NPS than single-domain MCI. More studies are needed to determine the prevalence and pathophysiology of the NPS in different MCI subtypes.

並列關鍵字

mild cognitive impairment ； neuropsychiatric symptoms ； apathy ； anxiety

國際替代計量

Neuropsychiatric Symptoms in Different Subtypes of Mild Cognitive Impairment

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