Abstract
ObjectiveWe studied progression to dementia and improvement rates of mild cognitive impairment (MCI) to help clinicians decide whether or not to screen older people for MCI.MethodProspective cohort study in which 156 vulnerable patients with (n = 24) and without (n = 132) MCI are followed and reassessed after two years with MMSE and Camdex.ResultsNine (38%) out of 24 patients initially diagnosed with MCI and 20 (15%) out of 132 considered normal or depressed progressed to dementia within two years. This results in a relative risk of progression of 2.48 (95% confidence interval = 1.29-4.77), a sensitivity of 31%(95%CI = 16-51) and a predictive value of 38% (95%CI = 20-59). Out of 24 people with MCI at baseline, 8 (33%; 95%CI = 16-55) had improved at follow-up.ConclusionThe low sensitivity of MCI for subsequent occurrence of dementia and the high improvement rate found in our study as well as by others, and the absence of a proven therapy, provide cumulative evidence against screening for MCI.
Highlights
Mild cognitive impairment or mild cognitive impairment (MCI) is a construct that has progressively emerged during the last ten years
The progression rate in MCI patients is quite stable in clinical samples (12% per year against around 1% in normal controls) as recently reviewed by Petersen [6], but far more heterogeneous in community samples (11-53 % after between 1 and 3 years) [7,8,9,10,11,12]
The progression rate has been found to be twice as high [13] or similar [14] when people with MCI and depression were compared to people with MCI only
Summary
Mild cognitive impairment or MCI is a construct that has progressively emerged during the last ten years It was called benign senescence forgetfulness [1], age-associated memory impairment [2] and age-associated cognitive decline [3], terms that relate to normal ageing. Important arguments in favour of labelling MCI as a diagnostic category would be a high predictive value for the subsequent emergence of dementia, a reasonable (say above 66%) sensitivity and an improvement rate that is negligible. If these criteria are met, the construct can be helpful for primary care physicians and screening would be advisable. It was three times higher (34% versus 11%) in people with MCI plus anxiety compared to MCI only [14]
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