Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2024; 12(6): 1063-1075
Published online Feb 26, 2024. doi: 10.12998/wjcc.v12.i6.1063
Correlative factors of poor prognosis and abnormal cellular immune function in patients with Alzheimer’s disease
Hua Bai, Hong-Mei Zeng, Qi-Fang Zhang, Yue-Zhi Hu, Fei-Fei Deng
Hua Bai, Department of Neurology, The Third Affiliated Hospital of Guizhou Medical University in China, Duyun 558099, Guizhou Province, China
Hong-Mei Zeng, Yue-Zhi Hu, Fei-Fei Deng, Department of Neurology, Guizhou Medical University, Duyun 558099, Guizhou Province, China
Qi-Fang Zhang, Key Laboratory of Medical Molecular Biology, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
Author contributions: Bai H contributed to study design, fundraising, and manuscript preparation; Bai H, Zeng HM, Hu YZ, and Deng FF contributed to investigation and data collection; Zeng HM, Zhang QF, and Bai H contributed to results analysis and discussion; all authors approved the final version of this manuscript.
Supported by the National Natural Science Foundation of China, No. 3206080019 and No. 32060182; Science and Technology Support Plan of Guizhou Province in China, No. [2020]4Y129; and Qiannan Prefecture Science and Technology Plan Project, No. [2022]01.
Institutional review board statement: The study was reviewed and approved by the Third Affiliated Hospital of Guizhou Medical University (Approval No. 20162160).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at baih2020@gmc.edu.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua Bai, MD, PhD, Full Professor, Department of Neurology, The Third Affiliated Hospital of Guizhou Medical University in China, No. 172 JianJiangbei Road, Duyun 558099, Guizhou Province, China. baih2020@gmc.edu.cn
Received: October 26, 2023
Peer-review started: October 26, 2023
First decision: December 15, 2023
Revised: December 21, 2023
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: February 26, 2024
Abstract
BACKGROUND

Alzheimer’s disease (AD) is a serious disease causing human dementia and social problems. The quality of life and prognosis of AD patients have attracted much attention. The role of chronic immune inflammation in the pathogenesis of AD is becoming more and more important.

AIM

To study the relationship among cognitive dysfunction, abnormal cellular immune function, neuroimaging results and poor prognostic factors in patients.

METHODS

A retrospective analysis of 62 hospitalized patients clinical diagnosed with AD who were admitted to our hospital from November 2015 to November 2020. Collect cognitive dysfunction performance characteristics, laboratory test data and neuroimaging data from medical records within 24 h of admission, including Mini Mental State Examination Scale score, drawing clock test, blood T lymphocyte subsets, and neutrophils and lymphocyte ratio (NLR), disturbance of consciousness, extrapyramidal symptoms, electroencephalogram (EEG) and head nucleus magnetic spectroscopy (MRS) and other data. Multivariate logistic regression analysis was used to determine independent prognostic factors. the modified Rankin scale (mRS) was used to determine whether the prognosis was good. The correlation between drug treatment and prognostic mRS score was tested by the rank sum test.

RESULTS

Univariate analysis showed that abnormal cellular immune function, extrapyramidal symptoms, obvious disturbance of consciousness, abnormal EEG, increased NLR, abnormal MRS, and complicated pneumonia were related to the poor prognosis of AD patients. Multivariate logistic regression analysis showed that the decrease in the proportion of T lymphocytes in the blood after abnormal cellular immune function (odd ratio: 2.078, 95% confidence interval: 1.156-3.986, P < 0.05) was an independent risk factor for predicting the poor prognosis of AD. The number of days of donepezil treatment to improve cognitive function was negatively correlated with mRS score (r = 0.578, P < 0.05).

CONCLUSION

The decrease in the proportion of T lymphocytes may have predictive value for the poor prognosis of AD. It is recommended that the proportion of T lymphocytes < 55% is used as the cut-off threshold for predicting the poor prognosis of AD. The early and continuous drug treatment is associated with a good prognosis.

Keywords: Alzheimer’s disease, Cellular immunity, Prognosis, T lymphocytes, Magnetic resonance spectroscopy

Core Tip: Abnormal cellular immune function, extrapyramidal symptoms, abnormal electroencephalogram, increased neutrophils and lymphocyte ratio, abnormal magnetic spectroscopy, and complicated pneumonia were related to the poor prognosis of Alzheimer’s disease (AD) patients. The decrease in the proportion of T lymphocytes in the blood after abnormal cellular immune function was an independent risk factor for predicting the poor prognosis of AD. The number of days of donepezil treatment to improve cognitive function was negatively correlated with modified Rankin scale score. The decrease in the proportion of T lymphocytes may have predictive value for the poor prognosis of AD.