Global clinical dementia rating of 0.5 in MCI masks variability related to level of function

被引：87

作者：

Chang, Y. -L. ^{[1
,2
]}

Bondi, M. W. ^{[2
,5
]}

McEvoy, L. K. ^{[3
]}

Fennema-Notestine, C. ^{[2
,3
]}

Salmon, D. P. ^{[4
]}

Galasko, D. ^{[4
,5
]}

Hagler, D. J., Jr. ^{[3
]}

Dale, A. M. ^{[3
,4
]}

机构：

[1] Natl Taiwan Univ, Dept Psychol, Taipei 10617, Taiwan

[2] Univ Calif San Diego, Dept Psychiat, La Jolla, CA 92093 USA

[3] Univ Calif San Diego, Dept Radiol, La Jolla, CA 92093 USA

[4] Univ Calif San Diego, Dept Neurosci, La Jolla, CA 92093 USA

[5] Vet Affairs San Diego Healthcare Syst, San Diego, CA USA

来源：

NEUROLOGY | 2011年 / 76卷 / 07期

关键词：

MILD COGNITIVE IMPAIRMENT; SURFACE-BASED ANALYSIS; HUMAN CEREBRAL-CORTEX; ALZHEIMERS-DISEASE; CORTICAL SURFACE; COMPLEX ACTIVITIES; COORDINATE SYSTEM; STRUCTURAL MRI; DEFICITS; SEGMENTATION;

D O I：

10.1212/WNL.0b013e31820ce6a5

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

Objective: To evaluate whether ratings on Clinical Dementia Rating (CDR) items related to instrumental activities of daily living (IADL) are associated with cognitive or brain morphometric characteristics of participants with mild cognitive impairment (MCI) and global CDR scores of 0.5. Methods: Baseline cognitive and morphometric data were analyzed for 283 individuals with MCI who were divided into 2 groups (impaired and intact) based on their scores on the 3 CDR categories assessing IADL. Rates of progression to Alzheimer disease (AD) over 2 years were also compared in the 2 groups. Results: The impaired IADL MCI group showed a more widespread pattern of gray matter loss involving frontal and parietal regions, worse episodic memory and executive functions, and a higher percentage of individuals progressing to AD than the relatively intact IADL MCI group. Conclusions: The results demonstrate the importance of considering functional information captured by the CDR when evaluating individuals with MCI, even though it is not given equal weight in the assignment of the global CDR score. Worse impairment on IADL items was associated with greater involvement of brain regions beyond the mesial temporal lobe. The conventional practice of relying on the global CDR score as currently computed underutilizes valuable IADL information available in the scale, and may delay identification of an important subset of individuals with MCI who are at higher risk of clinical decline. Neurology (R) 2011; 76: 652-659

引用

页码：652 / 659

页数：8