Abstract
Background:Progression trajectories of patients with mild cognitive impairment (MCI) are currently not well understood.Objective:To classify patients with incident MCI into different latent classes of progression and identify predictors of progression class.Methods:Participants with incident MCI were identified from the US National Alzheimer’s Coordinating Center Uniform Data Set (09/2005-02/2019). Clinical Dementia Rating (CDR®) Dementia Staging Instrument-Sum of Boxes (CDR-SB), Functional Activities Questionnaire (FAQ), and Mini-Mental State Examination (MMSE) score longitudinal trajectories from MCI diagnosis were fitted using growth mixture models. Predictors of progression class were identified using multivariate multinomial logistic regression models; odds ratios (ORs) and 95% confidence intervals (CIs) were reported.Results:In total, 21%, 22%, and 57% of participants (N = 830) experienced fast, slow, and no progression on CDR-SB, respectively; for FAQ, these figures were 14%, 23%, and 64%, respectively. CDR-SB and FAQ class membership was concordant for most participants (77%). Older age (≥86 versus≤70 years, OR [95% CI] = 5.26 [1.78–15.54]), one copy of APOE ɛ4 (1.94 [1.08–3.47]), higher baseline CDR-SB (2.46 [1.56–3.88]), lower baseline MMSE (0.85 [0.75–0.97]), and higher baseline FAQ (1.13 [1.02–1.26]) scores were significant predictors of fast progression versus no progression based on CDR-SB (all p < 0.05). Predictors of FAQ class membership were largely similar.Conclusion:Approximately a third of participants experienced progression based on CDR-SB or FAQ during the 4-year follow-up period. CDR-SB and FAQ class assignment were concordant for the vast majority of participants. Identified predictors may help the selection of patients at higher risk of progression in future trials.
Highlights
Alzheimer’s disease (AD) is a debilitating neurodegenerative disorder that greatly impairs the quality of life of patients and close family membersJ
All predictors identified as significant at the 5% level from the univariate analyses were subsequently included in the multivariate multinomial logistic regression (MNL) models from which we report odds ratios (ORs) and 95% confidence intervals (CIs) for all candidate predictors of latent class membership retained from the univariate analyses
National Alzheimer’s Coordinating Center (NACC) participants newly diagnosed with mild cognitive impairment (MCI) were classified in three latent classes of progression based on CDR-Sum of Boxes (CDR-SB) and Functional Activities Questionnaire (FAQ) score trajectories
Summary
Alzheimer’s disease (AD) is a debilitating neurodegenerative disorder that greatly impairs the quality of life of patients and close family membersJ. Clinical Dementia Rating (CDR®) Dementia Staging Instrument-Sum of Boxes (CDR-SB), Functional Activities Questionnaire (FAQ), and Mini-Mental State Examination (MMSE) score longitudinal trajectories from MCI diagnosis were fitted using growth mixture models. Results: In total, 21%, 22%, and 57% of participants (N = 830) experienced fast, slow, and no progression on CDR-SB, respectively; for FAQ, these figures were 14%, 23%, and 64%, respectively. CDR-SB and FAQ class membership was concordant for most participants (77%). Older age (≥86 versus ≤ 70 years, OR [95% CI] = 5.26 [1.78–15.54]), one copy of APOE 4 (1.94 [1.08–3.47]), higher baseline CDR-SB (2.46 [1.56–3.88]), lower baseline MMSE (0.85 [0.75–0.97]), and higher baseline FAQ (1.13 [1.02–1.26]) scores were significant predictors of fast progression versus no progression based on CDR-SB (all p < 0.05). Identified predictors may help the selection of patients at higher risk of progression in future trials
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