轻度行为损害与阿尔茨海默病相关研究的进展

doi:10.16150/j.1671-2870.2025.05.011

摘要/Abstract

摘要：

轻度行为损害（mild behavioral impairment，MBI）是中老年（50岁以上）发生的一系列精神行为症状，以情感失调和冲动失控为主，包括抑郁、躁狂以及幻觉、妄想等，是认知下降的早期预警信号，与阿尔茨海默病（Alzheimer′s disease，AD）的病理进程相关，且可早于痴呆症状出现多年。MBI在认知功能正常人群中的患病率约10%，而在轻度认知功能障碍（mild cognitive impairment， MCI）人群中该比例显著升高至14%~50%。然而，在临床实践中，由于MBI症状的复杂性和非特异性，其与AD间的潜在关联常被低估或忽视。近年来，随着AD诊断标志物的深入研究，MBI与AD的内在联系已逐步被揭示。横断面研究证实，MBI与脑脊液Aβ42水平降低及脑内Aβ沉积负荷增加显著相关。纵向研究进一步揭示，MBI症状与高Aβ沉积程度及认知衰退速率呈正相关，但与tau蛋白病理间的关联仍存在争议。MBI与AD特征性脑萎缩存在空间一致性，如海马体、杏仁核和内嗅皮层等。上述证据链共同支持MBI作为AD临床前阶段神经精神标志物的重要地位。为了更好地在早期识别AD，本文旨在强调临床实践中需建立神经精神症状-认知衰退多维评估框架，提醒临床医生对老年期的异常精神行为提高重视，以提升AD临床前阶段的识别率。

关键词: 轻度行为损害, 阿尔茨海默病, 精神行为症状, 生物标志物, 神经影像学, 认知下降

Abstract:

Mild behavioral impairment (MBI) refers to a series of neuropsychiatric symptoms in adults aged ≥50 years, primarily characterized by affective dysregulation and impulse control deficits, including depression, mania, hallucinations, and delusions. As an early harbinger of cognitive decline, MBI is intrinsically linked to the pathological progression of Alzheimer's disease (AD) and may appear several years before the onset of dementia symptoms. Its prevalence is approximately 10% in cognitively normal populations, increasing to 14%-50% among individuals with mild cognitive impairment (MCI). However, in clinical practice, the potential associations between MBI and AD are often underestimated or overlooked due to the complexity and non-specificity of MBI symptoms. In recent years, with in-depth research on AD biomarkers, the intrinsic relationship between MBI and AD has been gradually revealed. Cross-sectional studies have confirmed that MBI is significantly associated with reduced cerebrospinal fluid (CSF) Aβ42 levels and elevated cerebral Aβ deposition burden. Longitudinal evidence further demonstrates positive associations between MBI severity, high Aβ deposition, and accelerated cognitive decline, though its links with tau pathology remain controversial. MBI shows spatial consistency with AD-characteristic brain atrophy, such as in the hippocampus, amygdala, and entorhinal cortex. Collectively, this evidence solidifies the important role of MBI as a neuropsychiatric biomarker in the preclinical stage of AD. To optimize early AD detection, this review aims to highlight the need to establish a multidimensional assessment framework integrating neuropsychiatric symptoms and cognitive decline in clinical practice and remind clinicians to heighten vigilance toward abnormal neuropsychiatric behaviors in the elderly, thereby improving the detection rate of the preclinical stage of AD.

Key words: Mild behavioral impairment, Alzheimer's disease, Neuropsychiatric symptoms, Biomarkers, Neuroima-ging, Cognitive decline

中图分类号:

R749.16
R446

李雨航, 肖世富, 岳玲. 轻度行为损害与阿尔茨海默病相关研究的进展[J]. 诊断学理论与实践, 2025, 24(05): 548-554.

LI Yuhang, XIAO Shifu, YUE Ling. Advances in research on association between mild behavioral impairment and Alzheimer′s disease[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(05): 548-554.

图/表 2

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时间	研究者	使用工具	研究对象	MBI流行病学数据
2018	Sheikn等^[13]	NPI	MCI	MCI 49%~85%；非MCI 28%~75%
2019	Matsuoka等^[12]	NPI	精神科和记忆门诊	精神科门诊，SCD 19.6%，MCI 50.0% 记忆诊所，SCD 76.5%，MCI 85.3%
2020	Rao等^[14]	NPI	记忆门诊	遗忘型MCI 41.13%
2020	Kassam等^[7]	MBI-C	所有认知状态人群	认知正常10%；MCI 14%
2022	Xu等^[15]	MBI-C	临床患者	MCI超过50%
2021	肖辛怡等^[16]	NPI	记忆门诊	MCI 42.6%；痴呆78.3%
2023	曾黎等^[17]	MBI-C	农村老人	农村老人32.97%
2024	Leow等^[18]	MBI-C	新加坡社区	MBI-C平均得分（2.52±4.54）分
2024	Cherkasov等^[19]	MBI-C	50岁以上老人	50岁以上65%
2024	Richey等^[20]	NPI-Q	社区老人	有头部损伤史的31.3%；没有头部损伤史的 26.0%