ENS 2009:記憶方面的抱怨可預測阿茲海默氏症 但不是血管型失智


  July 7, 2009 (義大利米蘭) — 新研究結果認為,自我查覺的記憶方面抱怨,屬於大腦白質方面的變化,可能是阿茲海默氏症的徵兆,但是,可能令人驚訝的是,並不是血管型失智的徵兆。
  
  主要作者,葡萄牙里斯本大學Santa Maria醫院的Ana Verdelho醫師向Medscape Neurology表示,我們發現,有白質變化的年長者,且抱怨有記憶問題時,有較高的失智風險。當我們分析失智的亞型時,阿茲海默氏症的風險最明顯,有記憶困難抱怨的年長者,其風險達17倍。
  
  共同作者,奧地利Graz大學的Franz Fazekas醫師在新聞稿中表示,有趣的是,記憶方面的抱怨在各個失智亞型中顯示的關係相當不同。自我察覺的記憶損失是阿茲海默氏症失智合併血管要素的預測因子,與其他風險因素無關,但是不是血管型失智的預測因子。
  
  他們的發現屬於European Leukoaraiosis and Disability (LADIS)研究的一部份,發表於歐洲神經協會第19屆會議。
  
  【治療血管風險因素】
  Verdelho醫師強調,根據他們的發現,年長者在記憶方面的抱怨有年紀相關的白質變化,可能是發生某種疾病的重要徵兆。我們在這些資料中所見的,是腦部血管變化與失智退化類型之間的複雜關聯,將可增加治療血管風險因素之重要性的警覺,可能有助於發現其他預防年紀相關腦部白質變化的治療方式。
  
  阿茲海默氏症協會醫療與科學主任William Thies博士在訪問中表示,這有點令人驚訝;我們或許預期看見更多的血管型失智,但他們發現的是更多的阿茲海默氏症。
  
  Thies博士表示,這是一個來自有高度品質團體的大型研究。他也稱讚那些參與試驗者,因為需要一段長時間的頻繁監測。他表示,這絕非一件容易的事情。
  
  【LADIS研究】
  Fazekas醫師指出,LADIS研究探討腦部白質改變與對年長者的智力和動作能力的影響。這項前溯的三年研究包括了11國的多所醫學中心,納入的病患有輕微神經、認知、或動作抱怨,或於顱內影像檢查時發現者。這些問題對日常生活沒有影響。
  
  研究者在開始時與每年對病患評估,根據綜合的臨床與功能性準則,包括神經心理量表,評估憂鬱,記憶抱怨方面的問題等。
  
  在每次追蹤訪視中,研究者將病患的認知狀態分類為失智、認知缺損但無失智,以及無認知缺損。
  
  研究者在研究開始時與研究結束時進行磁振造影。他們根據Fazekas氏量表對白質變化進行分類。且使用存活者的Cox回歸分析,以評估失智與失智亞型的預測因子。
  
  研究者在會議中發表的分析鎖定639名病患。三年後,90名病患成為失智。其中,有34例分類為阿茲海默氏症失智合併血管要素,54名為血管型失智,2名為額顳葉失智症。其他有147名病患顯示某種程度的認知缺損,但不是失智。
  
  Thies博士表示,顯然地,如果腦部有所傷害,病患很快就會出現症狀。
  
  研究者宣告沒有相關財務關係。
  
  歐洲神經協會第19屆會議:摘要O153。發表於2009年6月23日。
  

ENS 2009: Memory Complaints Predict Alzheimer's Disease but Not Vascular Dementia

By Allison Gandey
Medscape Medical News

July 7, 2009 (Milan, Italy) — Self-perceived memory impairment in the setting of white-matter changes may signal Alzheimer's, but, perhaps surprisingly, not vascular dementia, new study results suggest.

"We found that elderly subjects with white-matter changes complaining of memory problems had a higher risk of dementia," lead author Ana Verdelho, MD, from the Santa Maria Hospital at the University of Lisbon, in Portugal, told Medscape Neurology. "When we analyzed the subtypes of dementia, the risk of Alzheimer's disease was remarkable — 17-fold higher in the elderly complaining of memory difficulties."

"Interestingly, memory complaints showed quite different associations with dementia subtypes," coauthor Franz Fazekas, MD, from the Medical University of Graz, in Austria, added in a news release. "Self-perceived memory impairment was a predictor of Alzheimer dementia with vascular component, independent of other risk factors, but was not a predictor of vascular dementia."

Their findings, part of the European Leukoaraiosis and Disability (LADIS) study, were presented here at the 19th Meeting of the European Neurological Society.

Treat Vascular Risk Factors

Dr. Verdelho emphasizes that according to the group's findings, a memory complaint in an elderly patient with age-related white-matter changes can be an important sign of things to come. "What we see from these data is the complex interaction between vascular brain changes and a degenerative type of dementia, which should increase the awareness of the importance of treating vascular risk factors and possibly also help find other options to prevent age-related cerebral white-matter changes."

"This is a little bit surprising," William Thies, PhD, chief medical and scientific officer at the Alzheimer's Association, said during an interview. "We might have expected to see more vascular dementia, but what they found was more Alzheimer's disease."

Dr. Thies said this is a big study from a "quality group." He also applauded those who participated in the trial because the study required commitment with frequent monitoring over a long period of time. "This would not have been the easiest study to be a part of," he said.

The LADIS Study

"The LADIS study examines brain white-matter changes and their influence on the intellectual and motor abilities of aging people," Dr. Fazekas noted. The prospective 3-year study includes medical centers in 11 countries.

Patients were enrolled because of minor neurological, cognitive, or motor complaints or incidental findings on cranial imaging. These problems had no reported impact on daily living.

Investigators evaluated patients at baseline and yearly with a comprehensive clinical and functional protocol including a neuropsychological battery, an evaluation for depression, and questions on memory complaints.

At each follow-up visit, investigators classified patient cognitive status as demented, cognitively impaired without dementia, and not cognitively impaired.

Investigators conducted magnetic resonance imaging at entry and at the end of the study. They rated white-matter changes according to the Fazekas scale. And to assess predictors of dementia and dementia subtypes, they used survival Cox regression analysis.

As part of the analysis presented at the meeting, researchers looked at 639 patients. After 3 years, 90 people had become demented. Of those, there were 34 cases classified as Alzheimer dementia with a vascular component, 54 had vascular dementia, and 2 had frontotemporal dementia. Another 147 patients showed some cognitive impairment, but not dementia.

"What seems to be clear," Dr. Thies said, "is if there is damage to the brain, patients will show symptoms sooner."

The researchers have disclosed no relevant financial relationships.

19th Meeting of the European Neurological Society: Abstract O153. Presented June 23, 2009.

    
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