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中华诊断学电子杂志 ›› 2018, Vol. 06 ›› Issue (03) : 145 -150. doi: 10.3877/cma.j.issn.2095-655X.2018.03.001

所属专题: 指南与规范 文献 指南共识

精神及心身相关疾病

新版轻度认知障碍临床指南概要
何昊1, 关青1,(), 张浩波1, 罗跃嘉1   
  1. 1. 518060 深圳大学心理与社会学院 深圳市情绪与社会认知科学重点实验室
  • 收稿日期:2018-01-28 出版日期:2018-08-26
  • 通信作者: 关青
  • 基金资助:
    国家自然科学基金(31571129;31700960;31500922)

Summary of the latest practice guideline on mild cognitive impairment

Hao He1, Qing Guan1,(), Haobo Zhang1, Yuejia Luo1   

  1. 1. Key Laboratory of Emotion and Social Cognitive Science of Shenzhen, College of Psychology and Sociology, Shenzhen University, Shenzhen 518060, China
  • Received:2018-01-28 Published:2018-08-26
  • Corresponding author: Qing Guan
  • About author:
    Corresponding author: Guan Qing, Email:
引用本文:

何昊, 关青, 张浩波, 罗跃嘉. 新版轻度认知障碍临床指南概要[J]. 中华诊断学电子杂志, 2018, 06(03): 145-150.

Hao He, Qing Guan, Haobo Zhang, Yuejia Luo. Summary of the latest practice guideline on mild cognitive impairment[J]. Chinese Journal of Diagnostics(Electronic Edition), 2018, 06(03): 145-150.

美国神经病学学会(AAN)近期发布了新版轻度认知障碍(MCI)临床指南,指南专家组根据AAN的证据分类标准,系统回顾了MCI的发病率、预后和治疗方面的文献,并提出相关建议。文献分析结果显示,MCI的发病率随着年龄的增长而升高,MCI患者较同龄对照群体有着更高的痴呆转化风险。尚无高质量证据显示药物对治疗MCI有效,但锻炼可提升MCI患者的认知测验成绩,认知训练也有改善认知功能的可能性。指南建议临床医师应采用有效的工具评估MCI,主要评估MCI患者的各种风险因素、功能损伤,并对MCI患者的行为/神经精神症状进行评估和治疗,检测MCI患者的认知状况,终止可能造成认知损伤的药物治疗,还应建议患者定期锻炼身体,亦可进行认知训练。指南不建议临床医师为MCI患者提供胆碱酯酶抑制剂。

The 2017 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI) has been published recently. The guideline panel systematically reviewed literatures on MCI prevalence, prognosis, and treatment according to AAN evidence classification criteria and provided recommendations based on the evidences. MCI prevalence increases with age. Individuals with MCI are at higher risk of progressing to dementia than age-matched controls. No high-quality evidence exists to support pharmacologic treatments effective for MCI. For patients with MCI, exercise training probably improve cognitive measures and cognitive training possibly improve cognitive ability. It is recommended that clinicians should assess MCI with validated tools, evaluate patients with MCI for modifiable risk factors and functional impairment, assess and treat behavioral/neuropsychiatric symptoms. Clinicians should monitor cognitive status of patients with MCI over time. Cognitively impairing medications should be discontinued. Clinicians should recommend regular exercise and cognitive training for patients. The guideline does not recommend that clinicians provide cholinesterase inhibitors for MCI patients.

表1 关于轻度认知障碍药物疗法的证据和结论
药物 证据分类 结论
多奈哌齐 3项Ⅱ级研究(Petersen 2005[e10],Doody 2009[e11],Salloway 2004[e12]) 服用3年以上多奈哌齐可能无助于降低MCI发展为痴呆的概率(证据可信度低,1项Ⅱ级研究[Petersen 2005[e10]])。尚不清楚多奈哌齐能否提升MCI患者在诸多认知测验中的成绩(证据可信度非常低,基于2项一致性较低、效应量较小的Ⅱ级研究)(Doody 2009[e11],Salloway 2004[e12])。Salloway研究中的置信区间无法排除一项重要的影响效应,且ADAS-Cog的改变虽然在统计学上显著,但不具有临床意义。
加兰他敏 2项Ⅱ级研究(Winblad 2008[e13],这两项研究报告在同一篇论文中) 服用2年以上加兰他敏很可能无助于降低MCI发展为痴呆的概率(证据可信度中等,基于2项Ⅱ级研究)。
利凡斯的明 1项Ⅱ级研究(Feldman 2007[e14]) 服用长达4年的利凡斯的明可能无助于降低MCI发展为痴呆的概率(证据可信度低,基于1项Ⅱ级研究)。
含类黄酮饮料 1项Ⅱ级研究(Desideri 2012[e15]) 尚无充分的证据支持或者反对,高剂量(约990 mg)类黄酮饮料能够在8周内提升MCI患者认知功能的综合测量指标(认知Z分数) (证据可信度非常低,基于1项Ⅱ级研究,其置信区间含有不重要的影响效应;剂量反应的证据也不清楚)。
降同型半胱氨酸-维生素B 1项Ⅱ级研究(Smith 2010[e16]) 尚无充分的证据支持或者反对对MCI患者采取降同型半胱氨酸治疗(证据可信度非常低,基于1项Ⅱ级研究,其可信度因采用了临床意义不明的主要终点而降低)。
经皮尼古丁贴剂 1项Ⅰ级研究(Newhouse 2012[e9]) 经皮给药尼古丁贴剂(15 mg/d) 6个月,有可能改善不吸烟的遗忘型MCI患者的认知测验成绩,但其在临床总体印象变化量表上的得分未见提高(证据可信度低,基于1项Ⅰ级研究,其可信度因击中反应时这一指标的临床意义不明而降低)。
吡贝地尔 1项Ⅲ级研究(Nagaraja 2001[e19]) 尚无充分的证据支持或者反对服用吡贝地尔能够改善MCI患者的认知功能(证据可信度非常低,基于1项Ⅲ级研究)。
罗非考昔a 1项Ⅱ级研究(Thal 2005[e17]) 罗非考昔有可能会增加MCI患者进展为AD的风险(证据可信度低,基于1项Ⅱ级研究)。
替莫瑞林注射剂 1项Ⅱ级研究(Baker 2012[e18]) 对MCI患者采取为期20周以上的替莫瑞林注射剂治疗有可能改善其多项认知测验指标(证据可信度低,基于1项Ⅱ级研究)b
V0191 1项Ⅲ级研究(Dubois 2012[e20]) 尚无充分的证据支持或者反对服用V0191能够改变MCI患者在ADAS-Cog中的反应率(证据可信度非常低,基于1项Ⅲ级研究)。
维生素E 1项Ⅱ级研究(Petersen 2005[e10]) 每天服用2 000 IU的维生素E可能无助于防止MCI患者进展为AD (证据可信度低,基于1项Ⅱ级研究)。
维生素E+维生素C 1项Ⅲ级研究(Naeini 2014[e21]) 每天口服300 mg维生素E和400 mg维生素C,持续服用超过12个月,对MCI可能没有干预效果(证据可信度非常低,基于1项Ⅲ级研究)。
表2 关于轻度认知障碍非药物疗法的证据和结论
[1]
Lutz W,Sanderson W,Scherbov S.The coming acceleration of global population ageing[J].Nature,2008,451(7179):716-719.
[2]
蒲慕明,徐波,谭铁牛.脑科学与类脑研究概述[J].中国科学院院刊,2016,31(7):725-736.
[3]
Petersen RC.Mild cognitive impairment[J].Continuum(Minneap Minn),2016,22(2 Dementia):404-418.
[4]
Petersen RC,Stevens JC,Ganguli M,et al.Practice parameter:early detection of dementia:mild cognitive impairment (an evidence-based review):report of the Quality Standards Subcommittee of the American Academy of Neurology[J].Neurology,2001,56(9):1133-1142.
[5]
Winblad B,Palmer K,Kivipelto M,et al.Mild cognitive impairment:beyond controversies,towards a consensus:report of the international working group on mild cognitive impairment[J].J Intern Med,2004,256(3):240-246.
[6]
Petersen RC.Mild cognitive impairment as a diagnostic entity[J].J Intern Med,2004,256(3):183-194.
[7]
Petersen RC,Smith GE,Waring SC,et al.Mild cognitive impairment:clinical characterization and outcome[J].Arch Neurol,1999,56(3):303-308.
[8]
Huey ED,Manly JJ,Tang MX,et al.Course and etiology of dysexecutive MCI in a community sample[J].Alzheimers Dement,2013,9(6):632-639.
[9]
Lyketsos CG,Lopez OL,Jones B,et al.A population-based study of the prevalence of neuropsychiatric disturbances in dementia and mild cognitive impairment:results from the Cardiovascular Health Study[J].JAMA,2002,288(12):1425-1483.
[10]
American Academy of Neurology.Clinical practice guideline process manual[M].St.Paul:American Academy of Neurology,2004.
[11]
American Academy of Neurology.Clinical practice guideline process manual[M].St.Paul,MN:American Academy of Neurology,2011.
[12]
Ganguli M,Dodge HH,Shen C,et al.Mild cognitive impairment,amnestic type:an epidemiologic study[J].Neurology,2004,63(1):115-121.
[13]
Fei M,Qu YC,Wang T,et al.Prevalence and distribution of cognitive impairment no dementia (CIND) among the aged population and the analysis of socio-demographic characteristics:the community-based cross-sectional study[J].Alzheimer Dis Assoc Disord,2009,23(2):130-138.
[14]
Bennett DA,Schneider JA,Bienias JL,et al.Mild cognitive impairment is related to Alzheimer disease pathology and cerebral infarctions[J].Neurology,2005,64(5):834-841.
[15]
Anstey KJ,Cherbuin N,Christensen H,et al.Follow-up of mild cognitive impairment and related disorders over four years in adults in their sixties:the PATH through Life Study[J].Dement Geriatr Cogn Disord,2008,26(3):226-233.
[16]
Di Carlo A,Lamassa M,Baldereschi M,et al.CIND and MCI in the Italian elderly:frequency,vascular risk factors,progression to dementia[J].Neurology,2007,68(22):1909-1916.
[17]
Hanninen T,Hallikainen M,Tuomainen S,et al.Prevalence of mild cognitive impairment:a population-based study in elderly subjects[J].Acta Neurol Scand,2002,106(3):148-154.
[18]
Louis ED,Schupf N, Manly J, et al. Association between mild parkinsonian signs and mild cognitive impairment in a community[J].Neurology,2005,64(7):1157-1161.
[19]
Purser JL,Fillenbaum GG,Wallace RB.Memory complaint is not necessary for diagnosis of mild cognitive impairment and does not predict 10-year trajectories of functional disability,word recall,or short portable mental status questionnaire limitations[J].J Am Geriatr Soc,2006,54(2):335-338.
[20]
Schonknecht P,Pantel J,Kruse A,et al.Prevalence and natural course of aging associated cognitive decline in a population-based sample of young-old subjects[J].Am J Psychiatry,2005,162(11):2071-2077.
[21]
Artero S,Ancelin ML,Portet F,et al.Risk profiles for mild cognitive impairment and progression to dementia are gender specific[J].J Neurol Neurosurg Psychiatry,2008,79(9):979-984.
[22]
Boyle PA,Wilson RS,Aggarwal NT,et al.Mild cognitive impairment:risk of Alzheimer disease and rate of cognitive decline see comment[J].Neurology,2006,67(3):441-445.
[23]
Busse A,Hensel A,Guhne U,et al.Mild cognitive impairment:long-term course of four clinical subtypes[J].Neurology,2006,67(12):2176-2185.
[24]
Das SK,Bose P,Biswas A,et al.An epidemiologic study of mild cognitive impairment in Kolkata,India[J].Neurology,2007,68(23):2019-2026.
[25]
Lobo A, Lopez-Anton R, de-la-Camara C, et al. Non-cognitive psychopathological symptoms associated with incident mild cognitive impairment and dementia,Alzheimer′s type[J].Neurotox Res,2008,14(2/3):263-272.
[26]
Lopez OL,Kuller LH,Becker JT,et al.Incidence of dementia in mild cognitive impairment in the Cardiovascular Health Study Cognition Study[J].Arch Neurol,2007,64(3):416-420.
[27]
Petersen RC,Roberts RO,Knopman DS,et al.Prevalence of mild cognitive impairment is higher in men:the Mayo Clinic Study of Aging[J].Neurology,2010,75(10):889-897.
[28]
Wilson RS,Schneider JA,Arnold SE,et al.Olfactory identification and incidence of mild cognitive impairment in older age[J].Arch Gen Psychiatry,2007,64(7):802-808.
[29]
Ganguli M,Chang CC,Snitz BE,et al.Prevalence of mild cognitive impairment by multiple classifications:the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) project[J].Am J Geriatr Psychiatry,2010,18(8):674-683.
[30]
Lopez OL,Jagust WJ,DeKosky ST,et al.Prevalence and classification of mild cognitive impairment in the Cardiovascular Health Study Cognition Study:part 1[J].Arch Neurol,2003,60(10):1385-1389.
[31]
Shi Z,Zhang Y,Yue W,et al.Prevalence and clinical predictors of cognitive impairment in individuals aged 80 years and older in rural China[J].Dement Geriatr Cogn Disord,2013,36(3/4):171-178.
[32]
Guaita A,Vaccaro R,Davin A,et al.Influence of socio-demographic features and apolipoprotein E epsilon 4 expression on the prevalence of dementia and cognitive impairment in a population of 70-74-year olds:the InveCe.Ab study[J].Arch Gerontol Geriatr,2015,60(2):334-343.
[33]
Anttila T,Helkala E,Viitanen M,et al.Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age:a prospective population based study[J].BMJ,2004,329(7465):539-542.
[34]
Barcelos-Ferreira R,Bottino C.Prevalence of amnestic mild cognitive impairment in depressed and nondepressed elderly Brazilian community residents[J].Alzheimers Dement,2014,10(4):907.
[35]
De Ronchi D,Palmer K,Pioggiosi P,et al.The combined effect of age,education,and stroke on dementia and cognitive impairment no dementia in the elderly[J].Dement Geriatr Cogn Disord,2007,24(4):266-273.
[36]
Ding D,Zhao Q,Guo Q,et al.Prevalence of mild cognitive impairment in an urban community in China:a cross-sectional analysis of the Shanghai Aging Study[J].Alzheimers Dement,2015,11(3):300-309,e302.
[37]
Gavrila D,Antunez C,Tormo MJ,et al.Prevalence of dementia and cognitive impairment in Southeastern Spain:the Ariadna study[J].Acta Neurol Scand,2009,120(5):300-307.
[38]
Hilal S,Ikram MK,Saini M,et al.Prevalence of cognitive impairment in Chinese:epidemiology of dementia in Singapore study[J].J Neurol Neurosurg Psychiatry,2013,84(6):686-692.
[39]
Kivipelto M,Helkala E,Hanninen T,et al.Midlife vascular risk factors and late-life mild cognitive impairment:a population-based study[J].Neurology,2001,56(12):1683-1689.
[40]
Lee SB,Kim KW,Youn JC, et al. Prevalence of mild cognitive impairment and its subtypes are influenced by the application of diagnostic criteria:results from the Korean Longitudinal Study on Health and Aging (KLoSHA)[J].Dement Geriatr Cogn Disord,2009,28(1):23-29.
[41]
Li X,Ma C,Zhang J,et al.Prevalence of and potential risk factors for mild cognitive impairment in community-dwelling residents of Beijing[J].J Am Geriatr Soc,2013,61(2):2111-2119.
[42]
Miyamoto M, Kodama C, Kinoshita T, et al. Dementia and mild cognitive impairment among non-responders to a community survey[J].J Clin Neurosci,2009,16(12):270-276.
[43]
Olazarán J,Valentí M,Frades B,et al.The vallecas project:a cohort to identify early markers and mechanisms of Alzheimer′s disease[J].Front Aging Neurosci,2015(7):181.
[44]
Petersen RC,Lopez O,Armstrong MJ,et al.Practice guideline update summary:mild cognitive impairment:report of the guideline development,dissemination,and implementation subcommittee of the American Academy of Neurology[J].Neurology,2018,90(3):126-135.
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