Baseline Mild Cognitive Impairment Research Articles

Cognitive predictors for five-year conversion to dementia in community-dwelling Chinese older adults

This study evaluates which cognitive measure is best for predicting incident dementia in a population-based random sample of Chinese older adults without dementia over a five-year period. A total of 787 community-dwelling Chinese older adults without dementia in Hong Kong were assessed at baseline (T0), at two years (T1), and at five years (T2). The annual conversion rate to dementia was 1.6% and 6.3% for baseline normal participants and baseline mild cognitive impairment (MCI) participants, respectively. The Cantonese version of Mini-mental State Examination (CMMSE) scores declined significantly over time. In participants who progressed to dementia, Category Verbal Fluency Test (CVFT) scores dropped significantly from T0 to T1. A 1-SD drop of either CMMSE or CVFT in two years predicted dementia at five years with 91.5% sensitivity and 62.0% specificity. A stable CMMSE and CVFT at two years predicted a 91% chance of not progressing to clinical dementia at five years. In this community sample of Chinese older adults, a decline in cognitive screening tests in short term (two years) offered useful information in predicting dementia conversion over a longer period.

P2‐336: Social isolation and quality of life in Alzheimer's dementia patients with Parkinson's disease

Background: Caring for someonewith dementia has been strongly linked to negative outcomes for caregivers such as burden or distress.However, little is known about whether Mild Cognitive Impairment (MCI) can also be linked to negative outcomes for co-habiting familymembers.Moreover, risk factors of poorpsychologicalwell-beingarenotwell established for this group.Examination of family supporters before they assume caregiving responsibilities may assist in identification of those vulnerable to psychological distress. Methods: We aimed to investigate the prevalence and predictors of psychological distress over time in co-habiting relatives of elders with and without MCI. Data from a large, population-based longitudinal study of people aged 70 to 90without dementia at baselinewere collected at baseline and after two years as regards participants’ socio-demographics, cognition, function and behavior, and family members’ psychological distress as measured by the Kessler Psychological Distress Scale (K10). On the K10, scores of 20 out of 50 indicate significant psychological distress. Linear regression analysis with K10 change scores as dependent variable was performed.Results:Of 1037 participants recruited, 327 (32%) had co-habiting family members who provided information about them. At baseline MCI prevalence in this subsample was 33%. Dementia incidence in participants with MCI in the two years following baseline was 2.8%. Rates of family members’ psychological distress were low at baseline and at 2-year follow-up (4.6 and 6.4%, respectively). After controlling for baseline K10 scores, worsening psychological distress was associated with family members’ greater physical disability at 2-year follow-up (b 1⁄4 -.0461, P<.001) as well as worse functional (ADLs) and cognitive (language) performance of the older person at baseline (b 1⁄4 -.162, P1⁄4 .004 and b1⁄4 -.123, P1⁄4 .023, respectively). The overall model accounted for 43% of variance (adjusted R 2.429).Conclusions:Characteristics of older people and their family members or a change thereof may influence family member’s psychological well-being over time. Longitudinal analyses of factors that contribute most toworsening of psychological distress in caring family members will allow identification of risk factors and of family members prone to negative outcomes from early in their caregiving career and provide opportunity for early intervention.

A composite score for executive functioning, validated in Alzheimer’s Disease Neuroimaging Initiative (ADNI) participants with baseline mild cognitive impairment

The Alzheimer's Disease Neuroimaging Initiative (ADNI) measures abilities broadly related to executive function (EF), including WAIS-R Digit Symbol Substitution, Digit Span Backwards, Trails A and B, Category Fluency, and Clock Drawing. This study investigates whether a composite executive function measure based on these multiple indicators has better psychometric characteristics than the widely used individual components. We applied item response theory methods to 800 ADNI participants to derive an EF composite score (ADNI-EF) from the above measures. We then compared ADNI-EF with component measures in 390 longitudinally-followed participants with mild cognitive impairment (MCI) with respect to: (1) Ability to detect change over time; (2) Ability to predict conversion to dementia; (3) Strength of cross-sectional association with MRI-derived measures of structures involved in frontal systems, and (4) Strength of baseline association with cerebrospinal fluid (CSF) levels of amyloid β₁₋₄₂, total tau, and phosphorylated tau(181P). ADNI-EF showed the greatest change over time, followed closely by Category Fluency. ADNI-EF needed a 40 % smaller sample size to detect change. ADNI-EF was the strongest predictor of AD conversion. ADNI-EF was the only measure significantly associated with all the MRI regions, though other measures were more strongly associated in a few of the regions. ADNI-EF was associated with all the CSF measures. ADNI-EF appears to be a useful composite measure of EF in MCI, as good as or better than any of its composite parts. This study demonstrates an approach to developing a psychometrically sophisticated composite score from commonly-used tests.

Does mild cognitive impairment affect the occurrence of radiographic knee osteoarthritis? A 3-year follow-up in the ROAD study

ObjectiveTo determine whether mild cognitive impairment (MCI) increases the risk of occurrence or progression of radiographic knee osteoarthritis (KOA) in a general population.DesignPopulation-based cohort study.SettingResidents in mountain and seaside areas...

Statins, Risk of Dementia, and Cognitive Function: Secondary Analysis of the Ginkgo Evaluation of Memory Study

Lipid-lowering medications (LLMs) and especially statin drugs can delay cognitive decline and dementia onset in individuals with and without mild cognitive impairment (MCI) at baseline. A longitudinal, observational study was conducted of 3069 cognitively healthy elderly patients (≥75 years of age) who were enrolled in the Ginkgo Evaluation of Memory Study. The primary outcome measure was the time to adjudicated all-cause dementia and Alzheimer dementia (AD). The secondary outcome measure was the change in global cognitive function over time measured by scores from the Modified Mini-Mental State Exam (3MSE) and the cognitive subscale of the AD Assessment Scale (ADAS-Cog). Among participants without MCI at baseline, the current use of statins was consistently associated with a reduced risk of all-cause dementia (hazard ratio [HR], 0.79; 95% confidence interval [95% CI], 0.65-0.96; P = .021) and AD (HR, 0.57; 95% CI, 0.39-0.85; P = .005). In participants who initiated statin therapy, lipophilic statins tended to reduce dementia risk more than nonlipophilic agents. In contrast, there was no significant association between LLM use (including statins), dementia onset, or cognitive decline in individuals with baseline MCI. However, in individuals without MCI at baseline, there was a trend for a neuroprotective effect of statins on cognitive decline. Statins may slow the rate of cognitive decline and delay the onset of AD and all-cause dementia in cognitively healthy elderly individuals, whereas individuals with MCI may not have comparable cognitive protection from these agents. However, the results from this observational study need to be interpreted with caution and will require confirmation by randomized clinical trials stratifying treatment groups based on MCI status at baseline.

Combined Clinical and Cognitive Criteria to Identify Mild Cognitive Impairment in a Southern Chinese Community

Mild Cognitive Impairment (MCI) is a recognized risk condition for clinical dementia. This paper attempted to explore the applicability of a combined cognitive and clinical approach to identify older Chinese adults at-risk of cognitive decline. Seven hundred forty randomly recruited community dwelling participants (aged 60 or over) were assessed at baseline and 2 years with Clinical Dementia Rating (CDR) and a cognitive battery. Baseline MCI groups were categorized by CDR-MCI, cognitive function (Cog-MCI), and a combined CDR-Cog approach. The cognitive approach adopted the Mayo clinic criteria. For the combined approach, nonamnestic MCI combined CDR 0.5 plus nonmemory cognitive deficits. The overall concordance between CDR and Cognitive test ratings were 65.3% (χ2 = 256.4, P<0.001, κ=0.44). With a combined approach, 424 (57%) participants were classified as normal. CDR-MCI group had higher cognitive scores compared with MCI groups by other criteria (1 way analysis of variance or ANOVA). At 2 years, the combined CDR-Cog MCI group identified all dementia (N=24) converters although group differences were not significant. Cognitive function and CDR identified participants potentially at-risk for furthermore decline, but exhibited some differences in detection profiles. A combined approach may be more practical in screening for MCI participants with diverse educational and cultural background.

&lt;emph type="ital"&gt;Ginkgo biloba&lt;/emph&gt; for Preventing Cognitive Decline in Older Adults&lt;subtitle&gt;A Randomized Trial&lt;/subtitle&gt;

The herbal product Ginkgo biloba is taken frequently with the intention of improving cognitive health in aging. However, evidence from adequately powered clinical trials is lacking regarding its effect on long-term cognitive functioning. To determine whether G. biloba slows the rates of global or domain-specific cognitive decline in older adults. The Ginkgo Evaluation of Memory (GEM) study, a randomized, double-blind, placebo-controlled clinical trial of 3069 community-dwelling participants aged 72 to 96 years, conducted in 6 academic medical centers in the United States between 2000 and 2008, with a median follow-up of 6.1 years. Twice-daily dose of 120-mg extract of G. biloba (n = 1545) or identical-appearing placebo (n = 1524). Rates of change over time in the Modified Mini-Mental State Examination (3MSE), in the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog), and in neuropsychological domains of memory, attention, visual-spatial construction, language, and executive functions, based on sums of z scores of individual tests. Annual rates of decline in z scores did not differ between G. biloba and placebo groups in any domains, including memory (0.043; 95% confidence interval [CI], 0.034-0.051 vs 0.041; 95% CI, 0.032-0.050), attention (0.043; 95% CI, 0.037-0.050 vs 0.048; 95% CI, 0.041-0.054), visuospatial abilities (0.107; 95% CI, 0.097-0.117 vs 0.118; 95% CI, 0.108-0.128), language (0.045; 95% CI, 0.037-0.054 vs 0.041; 95% CI, 0.033-0.048), and executive functions (0.092; 95% CI, 0.086-0.099 vs 0.089; 95% CI, 0.082-0.096). For the 3MSE and ADAS-Cog, rates of change varied by baseline cognitive status (mild cognitive impairment), but there were no differences in rates of change between treatment groups (for 3MSE, P = .71; for ADAS-Cog, P = .97). There was no significant effect modification of treatment on rate of decline by age, sex, race, education, APOE*E4 allele, or baseline mild cognitive impairment (P > .05). Compared with placebo, the use of G. biloba, 120 mg twice daily, did not result in less cognitive decline in older adults with normal cognition or with mild cognitive impairment. clinicaltrials.gov Identifier: NCT00010803.

Persistent mild cognitive impairment in geriatric depression

Cognitive impairment often occurs with geriatric depression and impairments may persist despite remission of depression. Although clinical definitions of mild cognitive impairment (MCI) have typically excluded depression, a neuropsychological model of MCI in depression has utility for identifying individuals whose cognitive impairments may persist or progress to dementia. At baseline and 1-year follow-up, 67 geriatric patients with depression had a comprehensive clinical examination that included depression assessment and neuropsychological testing. We defined MCI by a neuropsychological algorithm and examined the odds of MCI classification at Year 1 for remitted depressed individuals with baseline MCI, and examined clinical, functional and genetic factors associated with MCI. Fifty-four percent of the sample had MCI at baseline. Odds of MCI classification at Year 1 were four times greater among patients with baseline MCI than those without. Instrumental activities of daily living were associated with MCI at Year 1, while age and APOE genotype was not. These results confirm previous observations that MCI is highly prevalent among older depressed adults and that cognitive impairment occurring during acute depression may persist after depression remits. Self-reported decline in functional activities may be a marker for persistent cognitive impairment, which suggests that assessments of both neuropsychological and functional status are important prognostic factors in the evaluation of geriatric depression.