Correlative factors of poor prognosis and abnormal cellular immune function in patients with Alzheimer's disease

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; Magnetic resonance spectroscopy; Prognosis; T lymphocytes.

Figure 1

Flowchart of the study. AD: Alzheimer’s disease.

Figure 2

Magnetic resonance imaging and corresponding magnetic spectroscopy images of an Alzheimer’s disease patient. The patient was a 55-year-old female with a 4-year course of disease and a Mini Mental State Examination Scale score of 14 points. A: Magnetic resonance imaging images (axial view) of the patient showed mild degeneration and atrophy in the hippocampus, deepening of multiple cerebral sulcus, suggesting mild brain atrophy; B: The corresponding magnetic spectroscopy pictures of the patient showed N-acetylaspartate 37mmol/L, creatine 26 mmol/L, and choline 39 mmol/L, indicating that there was a metabolic disorder of brain neurotransmitters.

Figure 3

Lymphocyte subsets in the blood of Alzheimer’s disease patients were detected by flow cytometry. A: T cell was detected by using Anti-human CD3e-PE (ebioscience); B: B cells were detected by using Anti-Human CD19-PerCP (BioLegend); C: Natural killer cells were detected by using anti-human CD56-APC (ebioscience). NK: Natural killer.

Figure 4

Receptor working curve of the predictive value of N-acetylaspartate/creatine ratio of magnetic spectroscopy for poor prognosis of Alzheimer’s disease. ROC: Receptor working curve.