Abstract
BackgroundConcerns about worsening memory (“memory concerns”; MC) and impairment in memory performance are both predictors of Alzheimer's dementia (AD). The relationship of both in dementia prediction at the pre-dementia disease stage, however, is not well explored. Refined understanding of the contribution of both MC and memory performance in dementia prediction is crucial for defining at-risk populations. We examined the risk of incident AD by MC and memory performance in patients with mild cognitive impairment (MCI).MethodsWe analyzed data of 417 MCI patients from a longitudinal multicenter observational study. Patients were classified based on presence (n = 305) vs. absence (n = 112) of MC. Risk of incident AD was estimated with Cox Proportional-Hazards regression models.ResultsRisk of incident AD was increased by MC (HR = 2.55, 95%CI: 1.33–4.89), lower memory performance (HR = 0.63, 95%CI: 0.56–0.71) and ApoE4-genotype (HR = 1.89, 95%CI: 1.18–3.02). An interaction effect between MC and memory performance was observed. The predictive power of MC was greatest for patients with very mild memory impairment and decreased with increasing memory impairment.ConclusionsOur data suggest that the power of MC as a predictor of future dementia at the MCI stage varies with the patients' level of cognitive impairment. While MC are predictive at early stage MCI, their predictive value at more advanced stages of MCI is reduced. This suggests that loss of insight related to AD may occur at the late stage of MCI.
Highlights
The syndrome of mild cognitive impairment [1] (MCI) has been established as a risk state for Alzheimer’s Dementia (AD)
In step 1, positive ApoE4 status (HR = 1.89, 95% Confidence Intervals (CI): 1.18–3.02) and lower CERAD-DR performance (HR = 0.63, 95% CI: 0.56–0.71) were associated with higher risk of developing incident Alzheimer’s dementia (AD), yielding acceptable model fit (Nagelkerkes R2 = 0.262)
In addition to CERAD-DR and ApoE4, presence of memory concerns’’ (MC) was associated with an increased risk of future AD (HR = 2.55, 95% CI: 1.33–4.89) and significantly increased model fit (D-Chi2 = 9.5, df = 1, p = 0.002, change in Nagelkerke’s R2 = 2.1%)
Summary
The syndrome of mild cognitive impairment [1] (MCI) has been established as a risk state for Alzheimer’s Dementia (AD). Compared to the current knowledge and standards of neuropsychological testing, the criterion of subjective report about cognitive decline in the definition of MCI is less elaborated. It is unknown whether more precise operationalization (either quantitatively or qualitatively) of this criterion may increase the predictive accuracy for AD in MCI patients. Concerns about worsening memory (‘‘memory concerns’’; MC) and impairment in memory performance are both predictors of Alzheimer’s dementia (AD). The relationship of both in dementia prediction at the pre-dementia disease stage, is not well explored. We examined the risk of incident AD by MC and memory performance in patients with mild cognitive impairment (MCI)
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