PDF(Pubmed)
Abstract：
UNASSIGNED: The lack of cognitive awareness, anosognosia, is a clinical deficit in Alzheimer\'s disease (AD) dementia. However, an increased awareness of cognitive function, hypernosognosia, may serve as a marker in the preclinical stage. Subjective cognitive decline (SCD) might correspond to the initial symptom in the dynamic trajectory of awareness, but SCD might be absent along with low awareness of actual cognitive performance in the preclinical stage. We hypothesized that distinct meta-cognitive profiles, both hypernosognosia and anosognosia, might be identified in preclinical-AD. This research evaluated the association between cerebrospinal fluid (CSF) AD biomarkers and the awareness of episodic memory, further exploring dyadic (participant-partner) SCD reports, in the preclinical Alzheimer\'s continuum.
UNASSIGNED: We analyzed 314 cognitively unimpaired (CU) middle-aged individuals (mean age: 60, SD: 4) from the ALFA+ cohort study. Episodic memory was evaluated with the delayed recall from the Memory Binding Test (MBT). Awareness of episodic memory, meta-memory, was defined as the normalized discrepancy between objective and subjective performance. SCD was defined using self-report, and dyadic SCD profiles incorporated the study partner\'s report using parallel SCD-Questionnaires. The relationship between CSF Aβ42/40 and CSF p-tau181 with meta-memory was evaluated with multivariable regression models. The role of SCD and the dyadic contingency was explored with the corresponding stratified analysis.
UNASSIGNED: CSF Aβ42/40 was non-linearly associated with meta-memory, showing an increased awareness up to Aβ-positivity and a decreased awareness beyond this threshold. In the non-SCD subset, the non-linear association between CSF Aβ42/40 and meta-memory persisted. In the SCD subset, higher Aβ-pathology was linearly associated with increased awareness. Individuals presenting only study partner\'s SCD, defined as unaware decliners, exhibited higher levels of CSF p-tau181 correlated with lower meta-memory performance.
UNASSIGNED: These results suggested that distinct meta-cognitive profiles can be identified in preclinical-AD. While most individuals might experience an increased awareness associated with the entrance in the AD continuum, hypernosognosia, some might be already losing insight and stepping into the anosognosic trajectory. This research reinforced that an early anosognosic profile, although at increased risk of AD-related decline, might be currently overlooked considering actual diagnostic criteria, and therefore its medical attention delayed.
UNASSIGNED: We analyzed 314 cognitively unimpaired (CU) middle-aged individuals (mean age: 60, SD: 4) from the ALFA+ cohort study. Episodic memory was evaluated with the delayed recall from the Memory Binding Test (MBT). Awareness of episodic memory, meta-memory, was defined as the normalized discrepancy between objective and subjective performance. SCD was defined using self-report, and dyadic SCD profiles incorporated the study partner\'s report using parallel SCD-Questionnaires. The relationship between CSF Aβ42/40 and CSF p-tau181 with meta-memory was evaluated with multivariable regression models. The role of SCD and the dyadic contingency was explored with the corresponding stratified analysis.
UNASSIGNED: CSF Aβ42/40 was non-linearly associated with meta-memory, showing an increased awareness up to Aβ-positivity and a decreased awareness beyond this threshold. In the non-SCD subset, the non-linear association between CSF Aβ42/40 and meta-memory persisted. In the SCD subset, higher Aβ-pathology was linearly associated with increased awareness. Individuals presenting only study partner\'s SCD, defined as unaware decliners, exhibited higher levels of CSF p-tau181 correlated with lower meta-memory performance.
UNASSIGNED: These results suggested that distinct meta-cognitive profiles can be identified in preclinical-AD. While most individuals might experience an increased awareness associated with the entrance in the AD continuum, hypernosognosia, some might be already losing insight and stepping into the anosognosic trajectory. This research reinforced that an early anosognosic profile, although at increased risk of AD-related decline, might be currently overlooked considering actual diagnostic criteria, and therefore its medical attention delayed.
摘要：
■缺乏认知意识，失认症,是阿尔茨海默病（AD）痴呆的临床缺陷。然而,对认知功能的认识增强，失认症,可以作为临床前阶段的标志物。主观认知下降（SCD）可能对应于意识动态轨迹中的初始症状，但是在临床前阶段，SCD可能伴随着对实际认知表现的低认识。我们假设不同的元认知概况，高视神经失认症和失认症,可能在临床前AD中被识别。这项研究评估了脑脊液（CSF）AD生物标志物与情景记忆意识之间的关联。进一步探索二元(参与者-合作伙伴)SCD报告，在临床前阿尔茨海默氏症的连续体中。
■我们分析了来自ALFA+队列研究的314名认知未受损（CU）中年人（平均年龄：60岁，SD：4）。通过记忆结合测试（MBT）的延迟回忆来评估情景记忆。情景记忆的意识，元内存,被定义为客观和主观绩效之间的归一化差异。SCD是使用自我报告定义的，和二元SCD配置文件使用并行SCD问卷纳入研究伙伴的报告。用多元回归模型评价CSFAβ42/40和CSFp-tau181与元记忆的关系。通过相应的分层分析，探讨了SCD和二元权变的作用。
■CSFAβ42/40与元记忆非线性相关，表现出提高的意识，直到Aβ阳性，并且超过此阈值的意识降低。在非SCD子集中，CSFAβ42/40与元记忆之间的非线性关联持续存在。在SCD子集中，较高的Aβ病理与意识增强呈线性相关.仅提供研究伙伴SCD的个人，定义为不知情的下跌者，表现出更高水平的CSFp-tau181与更低的元记忆性能相关。
■这些结果表明，在临床前AD中可以识别出不同的元认知谱。虽然大多数人可能会经历与AD连续体中的入口相关的意识增强，失认症,有些人可能已经失去了洞察力，进入了anosognosic的轨迹。这项研究证实了早期的失语症，尽管AD相关下降的风险增加，考虑到实际的诊断标准，目前可能会被忽视，因此，它的医疗护理被推迟了。
■我们分析了来自ALFA+队列研究的314名认知未受损（CU）中年人（平均年龄：60岁，SD：4）。通过记忆结合测试（MBT）的延迟回忆来评估情景记忆。情景记忆的意识，元内存,被定义为客观和主观绩效之间的归一化差异。SCD是使用自我报告定义的，和二元SCD配置文件使用并行SCD问卷纳入研究伙伴的报告。用多元回归模型评价CSFAβ42/40和CSFp-tau181与元记忆的关系。通过相应的分层分析，探讨了SCD和二元权变的作用。
■CSFAβ42/40与元记忆非线性相关，表现出提高的意识，直到Aβ阳性，并且超过此阈值的意识降低。在非SCD子集中，CSFAβ42/40与元记忆之间的非线性关联持续存在。在SCD子集中，较高的Aβ病理与意识增强呈线性相关.仅提供研究伙伴SCD的个人，定义为不知情的下跌者，表现出更高水平的CSFp-tau181与更低的元记忆性能相关。
■这些结果表明，在临床前AD中可以识别出不同的元认知谱。虽然大多数人可能会经历与AD连续体中的入口相关的意识增强，失认症,有些人可能已经失去了洞察力，进入了anosognosic的轨迹。这项研究证实了早期的失语症，尽管AD相关下降的风险增加，考虑到实际的诊断标准，目前可能会被忽视，因此，它的医疗护理被推迟了。
