The role of mild behavioral impairment in Alzheimer's disease
Upload time：2017-02-21 Browse：
Author: Liu Chunyan, Li Yanfeng, Xing Yan
Abstract: mild behavioral disorders (mild behavioral impairment, MBI) in pre dementia and mild cognitive impairment (mild cognition, impairment, MCI) during the period of high incidence, increases the risk of the occurrence and progression of dementia, the symptoms are often clinicians, patients and their families to ignore. Identifying the concept of MBI, combined with other accurate diagnosis of dementia occurrence and progression markers, is helpful to the early identification of dementia.
Keywords: behavioral disorders; cognitive impairment; dementia; Alzheimer's disease
CLC number: R749.1+3; R742.8+9 document identification code: A article number: 1006-2963 (2017)
Alzheimer's disease (Alzheimer disease AD) commonly known as Alzheimer's disease, three major symptoms include cognitive deterioration, loss of ability of daily life and mental symptoms, once all of the above symptoms, often in a serious stage of disease, poor treatment effect. Therefore, it is of great significance to improve the early recognition rate of AD, so the early marker of dementia has been the focus of research. It was found that some of the  markers or indicators of dementia and progress of early warning function, such as the subjective cognitive decline (subjective cognitive, decline, SCD), cerebrospinal fluid abnormalities, amyloid beta (A beta 1-42) decreased, total tau (T-tau) or phosphorylated tau (P-tau), molecular imaging (abnormal increase amyloid PET protein positive) and abnormal gene (PSEN1, PSEN2 or APP), greatly promote the early prevention and treatment of AD.
A recent study found that  (mild behavioral impairment mild behavioral disorders, MBI) in pre dementia can not only can predict the occurrence of dementia, but also may indicate the speed of progression to dementia, early warning signal is also very likely AD. The 2016 International Conference on Alzheimer's disease association (International Conference on Alzheimer Association, AAIC) on the launch of MBI, that MBI is a memory disorder onset "earlier," a specific period to the definition of dementia". In this paper, the concept of MBI, the relationship between MBI and dementia, scale assessment, diagnostic criteria, treatment methods were reviewed.
1 MBI concepts and epidemiological studies
The study of dementia, especially in the early stages of dementia, promoted MBI. MBI is a mild behavioral disorder that occurs in the elderly with dementia, and is characterized by psychotic symptoms, emotional or behavioral symptoms in neuropsychiatric symptoms (neuropsychiatric symptoms, NPS). The NPS study of frontotemporal dementia is more, the exact role of early warning. NPS studies of AD and other dementias are mostly limited to symptom control. This paper focuses on the early warning function of MBI to AD.
In 2012, a population based study showed that , MCI in patients with NPS accounted for 31%, the proportion of cognitively normal individuals was as high as 15.1%. Recent studies have also shown that the prevalence of NPS in AD and other types of dementia can reach 80%~100%, and with the exacerbation of the disease continues to rise. Woolley  results showed that before the diagnosis of AD and 28.2% of patients had a diagnosis of depression, 52.2% patients had a diagnosis of frontotemporal dementia NPS. Van der Mussele et al. Reported a high prevalence of NPS in patients with MCI: the incidence of aggressive behavior was 49%, with an emotional abnormality of 45% and an anxiety of 38% (). The high prevalence rate of the latest data from the 2016 meeting of the AAIC Ismail Canada and colleagues on memory center survey of [6-7]:SCD and MCI in patients with NPS (76.5% and 83.5%), emotional disorders in MBI were 77.8%, 64.4%, 51.7% lack of impulse control disorders, social adaptation disorders 27.8%, 8.7% mental disease; caregiver burden score in MBI is no behavioral symptoms increased significantly (19.1 vs 5.4, P<0.01). Different studies for the crowd, culture, etc., the main symptoms and the incidence of NPS are different, but all show that AD and MCI in the early stage of high incidence of MBI, need to be alert to this clinical phenomenon.
2 MBI early warning of dementia
AD is a progressive disease, there is a longer period of asymptomatic phase that is clinically early, then gradually developed into MCI phase, continue to progress to AD. Clinical studies, neuroimaging, molecular biology, neurobiology, pathology and other studies suggest that MBI may be dementia
Department of Neurology, General Hospital of China Aviation, Chinese Academy of Sciences (Liu Chunyan, Xing Yan), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences,, Beijing 100012, China
Correspondent: Xing Yan, Email: email@example.com
Early warning signal.
2.1 A Clinical Study of 1010 cases for the study of  found that changes to apathy, depression and anxiety, irritability and nocturnal behavior common symptoms of NPS MCI, the patients were followed for 3 years, 27% of patients progressed to AD, a retrospective analysis found the relationship between apathy and transformation is most closely. In 2009 Taragano  for MCI and NPS combination of different severity subgroups were found, with only MBI or the risk of dementia was significantly higher than that in MCI group; the dementia conversion in pure MBI development for frontotemporal dementia high proportion of MCI or MCI+NPS into AD with high proportion, prompt accurate grasp the cognitive and behavioral symptoms can help predict dementia conversion. A large study included more than 2 thousand cases of patients with , the evaluation of cognition and behavior, the behavior of mental and nervous symptom scale (neuropsychiatric inventory, NPI) and geriatric depression scale, long-term follow-up results showed that NPI increased nocturnal sleep problems, mood swings, depression outcome was the risk of AD in elderly depression in the scale of energy decline, agency