Subtypes of cognitive impairment in cerebellar disease identified by cross-diagnostic cluster-analysis: results from a German multicenter study.

IF 4.6 2区医学 Q1 CLINICAL NEUROLOGY Journal of Neurology Pub Date : 2024-12-21 DOI:10.1007/s00415-024-12831-1

Qi Liu, Kerstin Rubarth, Jennifer Faber, Patricia Sulzer, Imis Dogan, Miriam Barkhoff, Martina Minnerop, Adam M Berlijn, Saskia Elben, Heike Jacobi, Julia-Elisabeth Aktories, Dana M Huvermann, Friedrich Erdlenbruch, Raquel Van der Veen, Johanna Müller, Enzo Nio, Benedikt Frank, Martin Köhrmann, Elke Wondzinski, Mario Siebler, Kathrin Reetz, Jürgen Konczak, Frank Konietschke, Thomas Klockgether, Matthis Synofzik, Sandra Röske, Dagmar Timmann, Andreas Thieme

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Abstract

Background: Cognitive and neuropsychiatric impairment, known as cerebellar cognitive affective syndrome (CCAS), may be present in cerebellar disorders. This study identified distinct CCAS subtypes in cerebellar patients using cluster analysis.

Methods: The German CCAS-Scale (G-CCAS-S), a brief screening test for CCAS, was assessed in 205 cerebellar patients and 200 healthy controls. K-means cluster analysis was applied to G-CCAS-S data to identify cognitive clusters in patients. Demographic and clinical variables were used to characterize the clusters. Multiple linear regression quantified their relative contribution to cognitive performance. The ability of the G-CCAS-S to correctly distinguish between patients and controls was compared across the clusters.

Results: Two clusters explained the variance of cognitive performance in patients' best. Cluster 1 (30%) exhibited severe impairment. Cluster 2 (70%) displayed milder dysfunction and overlapped substantially with that of healthy controls. Cluster 1 patients were on average older, less educated, showed more severe ataxia and more extracerebellar involvement than cluster 2 patients. The cluster assignment predicted cognitive performance even after adjusting for all other covariates. The G-CCAS-S demonstrated good discriminative ability for cluster 1, but not for cluster 2.

Conclusions: The variance of cognitive impairment in cerebellar disorders is best explained by one severely affected and one mildly affected cluster. Cognitive performance is not only predicted by demographic/clinical characteristics, but also by cluster assignment itself. This indicates that factors that have not been captured in this study likely have effects on cognitive cerebellar functions. Moreover, the CCAS-S appears to have a relative weakness in identifying patients with only mild cognitive deficits.

Study registration: The study has prospectively been registered at the German Clinical Study Register ( https://www.drks.de ; DRKS-ID: DRKS00016854).

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通过交叉诊断聚类分析确定的小脑疾病认知障碍亚型：来自德国多中心研究的结果

背景：认知和神经精神障碍，被称为小脑认知情感综合征（CCAS），可能存在于小脑疾病中。本研究通过聚类分析确定了小脑患者不同的CCAS亚型。方法：采用德国CCAS量表（G-CCAS-S）对205例小脑患者和200例健康对照者进行CCAS简易筛查。对G-CCAS-S数据进行k均值聚类分析，以确定患者的认知聚类。使用人口统计学和临床变量来描述群集。多元线性回归量化了它们对认知表现的相对贡献。G-CCAS-S正确区分患者和对照组的能力进行了跨集群的比较。结果：两个聚类最能解释患者认知表现的差异。第1组（30%）表现出严重的损伤。第2组（70%）表现出较轻的功能障碍，与健康对照者基本重叠。第1组患者平均年龄较大，受教育程度较低，表现出更严重的共济失调和更多的小脑外受累。即使在调整了所有其他协变量之后，聚类分配预测了认知表现。G-CCAS-S对聚类1的识别能力较好，对聚类2的识别能力较差。结论：小脑障碍患者认知功能障碍的差异最好由一个重度和一个轻度发病群来解释。认知表现不仅可以通过人口统计学/临床特征来预测，还可以通过聚类分配本身来预测。这表明在这项研究中没有捕捉到的因素可能对认知小脑功能有影响。此外，CCAS-S在识别只有轻度认知缺陷的患者方面似乎有相对的弱点。研究注册：该研究已在德国临床研究注册中心(https://www.drks.de；DRKS-ID: DRKS00016854)。

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来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.