Ihika Rampalli, Valory N Pavlik, Melissa M Yu, Jeffrey Bishop, Chi-Ying R Lin
{"title":"认知功能仍与深度痴呆症的功能障碍有关:阿尔茨海默病和路易体痴呆症。","authors":"Ihika Rampalli, Valory N Pavlik, Melissa M Yu, Jeffrey Bishop, Chi-Ying R Lin","doi":"10.1212/CPJ.0000000000200262","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>The Baylor Profound Mental Status Examination (BPMSE) was developed to assess cognitive function in the profound stage of dementia. The Clinical Dementia Rating (CDR) scale has been widely used in measuring functional performance in dementia. We aimed to determine whether cognitive function is related to overall functional impairment in profound dementia.</p><p><strong>Methods: </strong>We selected 864 patients with probable Alzheimer disease (AD) and 25 patients with possible dementia with Lewy Bodies (DLB) cases with profound dementia by Mini-Mental Status Examination or/and clinical global impression. We used BPMSE to measure cognitive function and the CDR sum-of-boxes (CDR-SB) score to determine overall functional status. We used Spearman rank order correlation to examine the univariate association between CDR-SB and BPMSE in the 2 diagnostic groups separately and multivariable regression analysis to investigate whether BPMSE remained associated with functional status after adjustment for age, sex, education, and <i>APOE</i> ε4 genotype. We expected to see an inverse correlation between BPMSE and CDR-SB scores based on the directionality of the rating scale scoring.</p><p><strong>Results: </strong>In both AD and DLB, total BPMSE scores had a significant inverse correlation with CDR-SB scores (AD: <i>r</i> = -0.453, <i>p</i> < 0.001; DLB: <i>r</i> = -0.489, <i>p</i> = 0.013). It is of interest that in DLB, the \"attention\" domain of BPMSE had the strongest association with CDR-SB (<i>r</i> = -0.700, <i>p</i> < 0.001) compared with other domains. The multivariable regression models showed that higher BPMSE scores (i.e., better cognitive function) remained significantly correlated with lower CDR-SB scores (i.e., better global function) in AD (CDR-SB: β = -0.340, <i>p</i> < 0.001), but the regression coefficient for BPMSE did not reach significance in the DLB model (CDR-SB: β = -0.298, <i>p</i> = 0.174).</p><p><strong>Discussion: </strong>In patients with AD and DLB who enter the profound dementia stage, cognitive function is associated with the severity of functional impairment. The lack of significance for DLB in multivariable regression could be due to small sample size because the correlation magnitude is similar to that in AD.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. 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We aimed to determine whether cognitive function is related to overall functional impairment in profound dementia.</p><p><strong>Methods: </strong>We selected 864 patients with probable Alzheimer disease (AD) and 25 patients with possible dementia with Lewy Bodies (DLB) cases with profound dementia by Mini-Mental Status Examination or/and clinical global impression. We used BPMSE to measure cognitive function and the CDR sum-of-boxes (CDR-SB) score to determine overall functional status. We used Spearman rank order correlation to examine the univariate association between CDR-SB and BPMSE in the 2 diagnostic groups separately and multivariable regression analysis to investigate whether BPMSE remained associated with functional status after adjustment for age, sex, education, and <i>APOE</i> ε4 genotype. We expected to see an inverse correlation between BPMSE and CDR-SB scores based on the directionality of the rating scale scoring.</p><p><strong>Results: </strong>In both AD and DLB, total BPMSE scores had a significant inverse correlation with CDR-SB scores (AD: <i>r</i> = -0.453, <i>p</i> < 0.001; DLB: <i>r</i> = -0.489, <i>p</i> = 0.013). It is of interest that in DLB, the \\\"attention\\\" domain of BPMSE had the strongest association with CDR-SB (<i>r</i> = -0.700, <i>p</i> < 0.001) compared with other domains. The multivariable regression models showed that higher BPMSE scores (i.e., better cognitive function) remained significantly correlated with lower CDR-SB scores (i.e., better global function) in AD (CDR-SB: β = -0.340, <i>p</i> < 0.001), but the regression coefficient for BPMSE did not reach significance in the DLB model (CDR-SB: β = -0.298, <i>p</i> = 0.174).</p><p><strong>Discussion: </strong>In patients with AD and DLB who enter the profound dementia stage, cognitive function is associated with the severity of functional impairment. The lack of significance for DLB in multivariable regression could be due to small sample size because the correlation magnitude is similar to that in AD.</p>\",\"PeriodicalId\":19136,\"journal\":{\"name\":\"Neurology. 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Cognitive Function Remains Associated With Functional Impairment in Profound Dementia: Alzheimer Disease and Dementia With Lewy Bodies.
Background and objectives: The Baylor Profound Mental Status Examination (BPMSE) was developed to assess cognitive function in the profound stage of dementia. The Clinical Dementia Rating (CDR) scale has been widely used in measuring functional performance in dementia. We aimed to determine whether cognitive function is related to overall functional impairment in profound dementia.
Methods: We selected 864 patients with probable Alzheimer disease (AD) and 25 patients with possible dementia with Lewy Bodies (DLB) cases with profound dementia by Mini-Mental Status Examination or/and clinical global impression. We used BPMSE to measure cognitive function and the CDR sum-of-boxes (CDR-SB) score to determine overall functional status. We used Spearman rank order correlation to examine the univariate association between CDR-SB and BPMSE in the 2 diagnostic groups separately and multivariable regression analysis to investigate whether BPMSE remained associated with functional status after adjustment for age, sex, education, and APOE ε4 genotype. We expected to see an inverse correlation between BPMSE and CDR-SB scores based on the directionality of the rating scale scoring.
Results: In both AD and DLB, total BPMSE scores had a significant inverse correlation with CDR-SB scores (AD: r = -0.453, p < 0.001; DLB: r = -0.489, p = 0.013). It is of interest that in DLB, the "attention" domain of BPMSE had the strongest association with CDR-SB (r = -0.700, p < 0.001) compared with other domains. The multivariable regression models showed that higher BPMSE scores (i.e., better cognitive function) remained significantly correlated with lower CDR-SB scores (i.e., better global function) in AD (CDR-SB: β = -0.340, p < 0.001), but the regression coefficient for BPMSE did not reach significance in the DLB model (CDR-SB: β = -0.298, p = 0.174).
Discussion: In patients with AD and DLB who enter the profound dementia stage, cognitive function is associated with the severity of functional impairment. The lack of significance for DLB in multivariable regression could be due to small sample size because the correlation magnitude is similar to that in AD.
期刊介绍:
Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.