Met Criteria For Mild Cognitive Impairment Research Articles

The interaction of obesity with susceptible gene polymorphisms in the relationship with mild cognitive impairment.

Mild cognitive impairment (MCI) in the elderly is threatening the mental health of the elderly, and the interaction of some factors is worth exploring. This study aims to explore the interactions of obesity and gene polymorphisms in the relationship with MCI. A total of 2555 community resident dwellings include 444 participants who met MCI criteria recruited from the Ningxia province of China. Fourteen MCI-susceptible single nucleotide polymorphisms were detected using a high-throughput mass spectrometer. The interaction was examined by performing the multifactor dimensionality reduction model and unconditional logistic regression model. Logistic regression showed that obesity (OR = 1.42, 95%CI: 1.04-1.94), rs2075650G allele carrying (OR = 17.95, 95%CI: 1.32-244.95), rs11556505T allele carrying (OR = 0.06, 95%CI: 0.01-0.87) were statistically associated with MCI. Multifactor dimensionality reduction analysis showed a strong antagonistic effect between obesity and rs4402960 (Interaction dendrogram between obesity and rs4402960 is red) and a weak synergy effect on rs7901695 (Interaction dendrogram between obesity and rs7901695 is green). The hierarchical analysis showed obesity is a risk factor for MCI in the non-rs4402960T allele carrier group (OR = 1.55, 95%CI: 1.02-2.35). This study found that obesity is an independent risk factor for MCI, and the interactions with MCI-susceptible gene polymorphisms suggest a possible precision preventive intervention program should be developed to reduce the risk of MCI among individuals with obesity in the community.

87 Not Normal but not MCI: Course of Memory over time

Objective:A diagnosis of mild cognitive impairment (MCI) requires memory complaint and objective memory impairment. However, some individuals report subjective memory complaints (SMC) despite having intact memory performance, while others demonstrate subtle impairment on memory testing but have no memory complaints; neither case would meet criteria for MCI. This study aimed to compare memory performances over time in individuals who do not meet traditional MCI criteria to those with normal cognition and those who converted to MCI.Participants and Methods:Diagnoses for a longitudinal sample from the Texas Alzheimer’s Research and Care Consortium were reviewed by a consensus panel of neuropsychologists and neurologists and reclassified at time of last visit. Diagnostic categories included SMC (i.e., memory complaint but no impairment on testing), objective cognitive impairment but no complaint (Impaired but not MCI), normal control (NC), MCI, and dementia. In this study, 827 participants were divided into 4 groups: 1) NC over 5 visits (n=511, 71% female; 42% Latinx/Hispanic), 2) baseline NC to amnestic MCI (n=62; 63% female; 57% Latinx/Hispanic), 3) SMC at last visit (n=133; 58% female; 70% Latinx/Hispanic), and 4) impaired but not MCI at last visit (n=121; 71% female; 60% Latinx/Hispanic). A memory composite (z-score) was created from the CERAD list-learning task (immediate, delayed, and recognition-discrimination) and Wechsler Memory Scale (Immediate and Delayed Logical Memory and Visual Reproduction) to evaluate memory performance over time. A linear mixed-model adjusting for age, education, sex, ethnicity, and number of APOE e4 alleles evaluated memory performance across 5 visits for the groups. To assess if depression followed a similar course, a linear mixed-model evaluated Geriatric Depression Scale (GDS) scores over time.Results:At baseline, groups differed by age (F=22.82; p<.001), education (F=8.60; p<.001), MMSE scores (F=9.38; p<.001), GDS-30 scores (F=3.56; p=.015), and memory composites (F=24.29; p<.001). A significant group X time interaction was observed (F=4.83, p<.001). Memory performance improved in both the SMC and the NC groups, remained stable in the impaired but not MCI group, and declined (as expected) in those who converted to amnestic MCI. Depression scores also showed a significant group X time interaction (F=2.43; p=.004), in which the NC to MCI group endorsed slightly more depression symptoms over time, while other groups declined or remained stable.Conclusions:Memory trajectories in this diverse sample differed across groups. Individuals with SMC but without objective memory impairment and normal controls showed some improvement in memory over time, presumably due to practice effects. Those with subtle memory impairments but no complaint (i.e., did not meet MCI criteria) remained stable and those who converted to amnestic MCI had worse memory across time. The stability of memory performances in the impaired not MCI group suggests these subtle memory inefficiencies may be longstanding or unperceived. However, because our sample achieved retrospective diagnoses of SMC and impaired not MCI, it will be important for future studies to prospectively follow these groups to determine which risk factors may predict progression to MCI and what impact ethnicity may have on these trajectories.

A - 19 Cognitive Test Score Dispersion VS. Traditional Memory Composite Scores: Predicting Mild Cognitive Impairment (MCI) & Dementia among Cognitively Impaired, Not MCI Patients.

To compare mild cognitive impairment (MCI) and dementia conversion rates between global neuropsychological dispersion (GD) and traditional memory neuropsychological composite score (MComp) in participants with baseline evidence of cognitive decline but no diagnosis of MCI or dementia. Data from the National Alzheimer's Coordinating Center (NACC) for 364 participants with a CDR of 0.5, no initial diagnosis of MCI or dementia, and five visits were analyzed. GD was the intraindividual standard deviation across baseline normative (NACC norms) neuropsychological performance. MComp was the mean of the four verbal and visual memory normed scores. Multinomial logistic regression models fit statistics compared GD and MComp as predictors of conversion to MCI/dementia, adjusting for age, sex, race, ethnicity, ApoE4 status, and stratified by suspected etiology (Alzheimer's disease [ad] or no-ad). Lower Akaike Information Criteria (AIC) values indicate better model fit and predictions. 37% progressed to MCI, and 47% to dementia by visit 5. 53% of these were suspected to have ad etiology, and 47% non-ad. MComp showed a better fit with significant predictions of MCI and dementia progression in both suspected ad (AIC: 351.77, p < 0.001) or non-ad etiology (AIC: 215.02, p < 0.004), versus GD was only significant for non-ad etiology (AIC: 385.74, p < 0.003). Better memory performance predicted a lower likelihood of conversion to non-ad MCI (B = -0.65, p = 0.003) and non-ad dementia (B = -1.33, p < 0.001). GD predicted eventual progression to non-ad dementia (B = 2.311, p = 0.004), but not non-ad MCI. Traditional memory composite score may be a better predictor of MCI and dementia conversion than cognitive dispersion in individuals with early cognitive decline who do not yet meet MCI criteria.

Predictors of Incident Mild Cognitive Impairment and Its Course in a Diverse Community-Based Population.

Background and ObjectivesTo investigate sociodemographic and medical predictors of incident mild cognitive impairment (MCI) and subsequent course of MCI at follow-up, including sustained MCI diagnosis, classification as cognitively normal, and progression to dementia.MethodsWithin a community-based cohort, diagnoses of MCI were made with a published algorithm. Diagnosis of dementia was based on clinical consensus. Cox regressions estimated hazard ratios of incident MCI associated with several predictors. Modified Poisson regressions estimated relative risks associated with predictors of diagnostic status at follow-up after incidence.ResultsAmong 2,903 cognitively normal participants at baseline, 752 developed MCI over an average of 6.3 (SD 4.5) years (incidence rate 56 per 1,000 person-years). Presence of APOE ε4 and higher medical burden increased risk of incident MCI, while more years of education, more leisure activities, and higher income decreased this risk. Of the incident MCI cases, after an average of 2.4 years of follow-up, 12.9% progressed to dementia, 9.6% declined in functioning and did not meet the algorithmic criteria for MCI but did not meet the clinical criteria for dementia, 29.6% continued to meet MCI criteria, and 47.9% no longer met MCI criteria. Multidomain MCI, presence of APOE ε4, depressive symptoms, and antidepressant use increased the risk of progression to dementia.DiscussionThis community-based study showed that almost half of the individuals with incident MCI diagnoses were classified as cognitively normal at follow-up. Predictors of incident MCI demonstrably differed from those of subsequent MCI course; these findings can refine expectations for cognitive and functional course of those presenting with MCI.

THE EFFECT OF ATTENTION PROCESS TRAINING (APT-II) ON COGNITIVE AND DAILY LIFE FUNCTIONING IN PATIENTS WITH A MILD COGNITIVE IMPAIRMENT: A RANDOMIZED CONTROLLED TRIAL

Introduction. Older adults with mild cognitive impairment (MCI) are at increased risk of developing dementia even if they do not meet the criteria for dementia. Executive control of working memory, which is implicated in divided attention, is often impaired in this population, and such impairment is a strong predictor of dementia. Slowing the development of dementia by enhancing cognitive and brain plasticity represents a current and future challenge for clinicians and researchers. Cognitive rehabilitation allows patients to compensate for cognitive deficits with the ultimate goal of reducing the impact of such deficits on everyday life. We aim to examine the effectiveness and generalization of an attention and working memory training program (Attention Process Training or APT-II) in improving cognitive and everyday functioning in patients with MCI by means of a single-blind, randomized controlled trial. Methods. Twenty-two MCI patients will be randomly assigned to either a "Cognitive Training with APT-II" group or a "Standard Care" group. Initially, patients will be administered a battery of standardized neuropsychological tests to ensure that they meet MCI criteria. The intervention will consist of a cognitive training program (APT-II) and will last 8 weeks (two sessions per week). One of the strengths of APT-II training is that it emphasizes the transfer of cognitive gains from training sessions to everyday life. To evaluate the treatment's effectiveness in improving cognitive and daily life functioning, cognitive and functional outcomes will be assessed just before, immediately after, 3 months after, and 6 months after the intervention program. A divided attention memory task performed in virtual reality will also be administered to evaluate the effects of APT-II training on the management of attentional resources in a relatively ecological situation. Perspective. If our results indicate an improvement in the cognitive and daily life performance of older adults with MCI, this non-invasive, low-cost technique may deserve increased consideration as a therapeutic intervention to delay or reverse cognitive decline an diminish the risk of developing dementia in this population. Trial registration. ClinicalTrials.gov, ID: NCT04606953, Registered on 28 October 2020. Keywords. Working memory training (WMT), Mild cognitive impairment (MCI), Dementia, Cognitive rehabilitation, Attention

Two-decade change in prevalence of cognitive impairment in the UK

Identification of individuals at high risk of dementia has usually focused attention on the clinical concept of mild cognitive impairment (MCI), which captures an intermediate state between normal cognitive ageing and dementia. In many countries age specific risk of dementia has declined, but whether this is also the case for subclinical cognitive impairment is unknown. This has important implications for prevention, planning and policy. Here we describe subclinical cognitive impairment and mild dementia prevalence changes, in the UK, over 2 decades. The Cognitive Function and Ageing Studies have examined the full spectrum of cognition, from normal to dementia, in representative populations of people aged ≥ 65 years in the UK over the last 2 decades 7635 participants were interviewed in CFAS I in Cambridgeshire, Newcastle, and Nottingham in 1991, with 1457 being diagnostically assessed. In the same geographical areas, the CFAS II investigators interviewed 7796 individuals in 2011. Using established criteria, the population was categorised into seven groups: no cognitive impairment, Mild cognitive Impairment (defined using consensus criteria), other cognitive impairment no dementia without functional impairment, OCIND with functional impairment, cognitive impairment (MMSE < 24 and no functional impairment), mild dementia (MMSE < 24 with functional impairment, not captured by CFAS dementia criteria), and CFAS dementia criteria. Multinomial logistic regression, adjusted for age and sex, was used to estimate the prevalence of impairment in both studies. Results were standardized to the age-sex specific UK and global population. There is a clear increase in the prevalence of other cognitive Impairment no Dementia (without functional impairment), with the purer MCI remaining stable. In the UK, mild dementia is estimated to fall from 520,704 cases (5.7%, 95% CI 3.8, 8.1) in 1991 to 315,142 (3.0%, 95% CI 2.4, 3.8) in 2011, cognitive impairment, has fallen from 1,225,984 (13.5%, 95% CI 10.1, 17.5) to 654,436 (6.3%, 95% CI 5.4, 7.3) cases. Using additional categories which reflect the continuum of cognitive decline and impairment in populations we see that the mildest dementia declines, but that there is stability in estimates of those who meet MCI criteria. Increases were found in the Other Cognitive Impairment no Dementia group. The decline observed in severe impairment thus seems to have resulted in larger proportions of the population in milder forms, seen alongside physical illnesses.

AFFECTIVE DISTURBANCE IN MILD COGNITIVE IMPAIRMENT

Introduction Mild cognitive impairment (MCI) is an identifiable, prodromal stage of cognitive impairment. To better identify the differences in patients with MCI, the diagnosis has been further defined into subtypes: amnestic, language, executive functioning, and multi-domain/mixed MCI (Jak et al. 2009). Determining these subtypes can be helpful in predicting the trajectory and prognosis of a patient's disease. Affective disturbance can be present in a number of different types of dementia and MCI and carries significant stress to both the patient and caregivers. The most common mood changes occur as depression, anxiety, apathy, and irritability (Hwang et al., 2004, Rozzini et al., 2008, Lulio et al., 2010). The appearance of these symptoms has been found in up to 50% of patients with dementia prior to the onset of neurocognitive symptoms and has been related to a more rapid neurocognitive decline (Trivedi et al., 2013, Gallagher et al. 2017). Consequently, there has been an increased interest in identifying both neurocognitive and neuropsychiatric symptoms as early as possible for quicker intervention. Previous papers have looked at affective disturbance in an individual subtype of MCI but not the differences between subtypes. The purpose of this study is to (1) examine the differences in depression, anxiety, and apathy between MCI subtypes; and (2) assess the relationship between the neurocognitive domains (executive functioning, language, and episodic memory) and affective symptoms. We hypothesize that apathy will be greater in dysexecutive/mixed MCI (dys/mixed MCI) and related to greater neurocognitive deficits compared to depression or anxiety. Methods This is a retrospective study of 111 patients from the New Jersey Institute for Successful Aging Memory Assessment Program (MAP) who were administered a comprehensive neuropsychological protocol assessing executive functioning, language, and episodic memory. All tests were administered by an experienced neuropsychologist. Patients meeting criteria for dementia were excluded. Affective symptoms of depression, anxiety, and apathy were assessed by caregiver report using the Neuropsychiatric Inventory (NPI). Differences in age, gender, and instrumental activities of daily living were also recorded. Using Jak, Bondi (2009) criteria neuropsychological test performance categorized patients as presenting with non-MCI (patients that do not meet MCI criteria), amnestic MCI (aMCI), or a combined dys/mixed MCI. Patients were assigned to the aMCI group if memory test scores were more than one standard deviation below the normative values in 2 of 3 episodic memory parameters. Patients were assigned to the dys/mixed MCI group if the test scores were more than one standard deviation below the normed mean in 2 of 3 tests across multiple neurocognitive domains. Patients with dysexecutive and mixed MCI were combined due to the small number of patients meeting criteria for dysexecutive MCI. Prior research has shown that dysexecutive MCI and mixed MCI patients present with similar patterns of impairment on executive tests (Bondi et al., 2014, Thomas et al., 2017, & Eppig et al., 2012). Results The three MCI groups will be compared on symptoms of depression, anxiety, and apathy as measured by the NPI, using analysis of co-variance. A second analysis will look at the three tests that comprise each of the three cognitive domains as they are related to anxiety, depression, and apathy using a step-wise multiple regression. Conclusions We hypothesize that apathy will be greater in dysexecutive/mixed MCI (dys/mixed MCI) and related to greater neurocognitive deficits compared to depression or anxiety. The results and conclusion will be completed soon for the poster as well as submission for publication. This research was funded by All resources were supplied by the Departments of Geriatrics, Gerontology, and Psychology, New Jersey Institute for Successful Aging, Rowan University-School of Osteopathic Medicine, Stratford, NJ, USA.

An Exploratory Study of Mild Cognitive Impairment of Retired Professional Contact Sport Athletes.

To test the hypothesis that mild cognitive impairment (MCI) rates are higher among retired professional contact sport athletes than in noncontact athlete controls and compare history of contact sports with other MCI risk factors. University Concussion Management Clinic. Twenty-one retired National Football League and National Hockey League players and 21 aged-matched noncontact athlete controls. Case-control. Comprehensive criteria were used to assess MCI based on the following: Wisconsin Card Sorting Test, Delis-Kaplan Executive Function System; Trail Making Parts A and B; Wechsler Adult Intelligence Scale-Third Edition subtests; Neuropsychological Assessment Battery Memory Module List Learning, Story Learning, and Naming subtests; and Controlled Oral Word Association Test. The Wide Range Achievement Test was used as a proxy measure for IQ. Atherosclerotic cardiovascular disease risk factors were self-reported and blood cholesterol was measured. Depression was measured by the Beck Depression Inventory-II (BDI). Eight contact sport athletes (38%) and 3 noncontact athletes (14%) met MCI criteria (P = .083). Contact sport athletes' scores were significantly worse on Letter Fluency and List B Immediate Recall. Contact athletes were more obese, had more vascular risk factors, and had higher scores on the BDI than controls. Athletes with a history of playing professional contact sports had more vascular risk factors and higher depression scores. MCI rates were somewhat higher, though not significant.

What Mild Cognitive Impairment Might Mean in Parkinson Patients

To examine mild cognitive impairment (MCI) in Parkinson disease (PD), investigators followed up on an incident population of patients newly diagnosed with PD who underwent neuropsychological testing over a 5-year period. The authors classified MCI dementia using the Movement Disorders Society level one criteria in the domains of attention, executive function, memory, and visuospatial ability. Twenty percent of 178 patients met MCI criteria at the first neuropsychological examination. The …

Intraindividual variability in psychometrically defined mild cognitive impairment status in older African Americans.

This study examines day-to-day variability in psychometrically defined mild cognitive impairment (MCI) status and potential predictors of changes in MCI status in an independent-living sample of urban dwelling older adults in Baltimore, Maryland. The participant sample consisted of 50 older adults, ranging in age from 50 to 80 years. Participants completed health and cognitive measures (i.e., executive function, language, memory, and global cognition) over 8 occasions within a 2-3-week period. After each testing occasion, a post hoc classification of MCI status was determined using psychometrically defined criteria based on cognitive performance. Participants who classified as MCI after one assessment often did not meet MCI criteria at subsequent occasions. Daily fluctuations in sleep duration were associated with an increased risk for MCI classification. These results demonstrate that changes in sleep may explain changes in MCI status, particularly for African Americans.

Neuropsychological measures predict decline to Alzheimer's dementia from mild cognitive impairment.

Studies of Mild Cognitive Impairment (MCI) show elevated rates of conversion to dementia at the group level. However, previous studies of the trajectory of MCI identify great heterogeneity of outcomes, with a significant proportion of individuals with MCI remaining stable over time, changing MCI subtype classification, or reverting to a normal cognitive state at long-term follow-up. The present study examined individual outcomes at 20 months in a group of older adults classified according to MCI subtypes. A total of 106 participants, 81 with different subtypes of MCI and 25 healthy controls, undertook longitudinal neuropsychological assessment of visual and verbal memory, attentional processing, executive functions, working memory capacity, and semantic memory. At 20 months 12.3% of the MCI group progressed to dementia, 62.9% continued to meet MCI criteria, and 24.7% reverted to unimpaired levels of function. A discriminant function analysis predicted outcome at 20 months on the basis of baseline neuropsychological test performance with 86.3% accuracy. The analysis indicated that a pattern of impairments on visual episodic memory, verbal episodic memory, short-term memory, working memory, and attentional processing differentiated between participants who developed dementia, recovered from MCI, or remained in stable MCI. The results of the present study raise questions regarding the specificity of existing criteria for the subtypes of MCI, with these results indicating a high degree of instability in classification over time. In addition, the results suggest that multidomain MCI is the most reliable precursor stage to the development of AD.

Prediction of Conversion from Mild Cognitive Impairment to Alzheimer Disease Based on Bayesian Data Mining with Ensemble Learning

Prediction of disease progress is of great importance to Alzheimer disease (AD) researchers and clinicians. Previous attempts at constructing predictive models have been hindered by undersampling, and restriction to linear associations among variables, among other problems. To address these problems, we propose a novel Bayesian data-mining method called Bayesian Outcome Prediction with Ensemble Learning (BOPEL). BOPEL uses a Bayesian-network representation with boosting, to allow the detection of nonlinear multivariate associations, and incorporates resampling-based feature selection to prevent over-fitting caused by undersampling. We demonstrate the use of this approach in predicting conversion to AD in individuals with mild cognitive impairment (MCI), based on structural magnetic-resonance and magnetic-resonance- spectroscopy data. This study includes 26 subjects with amnestic MCI: the converter group (n = 8) met MCI criteria at baseline, but converted to AD within five years, whereas the non-converter group (n = 18) met MCI criteria at baseline and at follow-up. We found that BOPEL accurately differentiates MCI converters from non-converters, based on the baseline volumes of the left hippocampus, the banks of the right superior temporal sulcus, the right entorhinal cortex, the left lingual gyrus, and the rostral aspect of the left middle frontal gyrus. Prediction accuracy was 0.81, sensitivity was 0.63 and specificity was 0.89. We validated the generated predictive model with an independent data set constructed from the Alzheimer Disease Neuroimaging Initiative database, and again found high predictive accuracy (0.75).

Apolipoprotein E allele 4 is not a sufficient or a necessary predictor of the development of Mild Cognitive Impairment

The presence of Mild Cognitive Impairment (MCI) and of an apolipoprotein E (apoE) ɛ4 allele both predict the development of Alzheimer's disease. However, the extent to which this allele also predicts the development of MCI is unclear even though MCI is an early transitional stage in the development of Alzheimer's disease. The present study investigates the prevalence of the apoE ɛ4 allele in incipient MCI. Participants were recruited from the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). All subjects who were initially cognitively healthy, i.e. did not meet MCI criteria described by Petersen [Petersen RC. Mild cognitive impairment. J Intern Med 2004; 256(3): 183–94], and whose apoE status could be determined were followed-up. After 4.5 years, 15.5% of the cognitively healthy target population had developed MCI. The frequencies of the apoE ɛ4 genotype did not differ between individuals with incipient MCI (12.9%) and individuals who remained cognitively healthy during the study (18.4%, p > 0.5). Consequently, the apoE ɛ4 genotype is not a necessary or sufficient risk factor for MCI. Further studies need to investigate the influence of the whole range of genetic and environmental risk factors on the course of Alzheimer's disease including the initial development of MCI and the later conversion to Alzheimer's disease.

P02-163 The use of MMSE to identify mild cognitive impairment (MCI). A population-based study

Aims:To evaluate the prevalence of MCI and its subtypes in the Faenza Project, using the Mini-Mental State Examination (MMSE).Methods:Subjects living in the municipality of Faenza were clinically assessed. The diagnosis of MCI was achieved according to international criteria using a double-step procedure: first, we excluded subjects with dementia, functional impairment and MMSE&lt; 24, leaving 6,745 persons. Then, the performance in different cognitive domains was considered and scores less than 1.5 standard deviations below the age- and education-adjusted norms on MMSE were settled as cut-offs. Four subtypes were identified: amnestic MCI, single non-memory MCI, multidomains non-amnestic, multidomains amnestic MCI.Results:2,720 (40.3%) participants met MCI criteria. Prevalence were 4% (amnestic MCI), 26.5% (single non-memory MCI), 4.4% (multidomains amnestic MCI), and 5.4% (multidomains non-amnestic MCI).Conclusions:MCI is common among Italian elderly. In our study prevalence are higher than reported in other population-based studies. The use of MMSE with different operational criteria, diverse sampling and assessment procedure might explain such discrepancy. The role of MMSE to identify persons with mild cognitive deficits deserves concerns. However, MMSE is largely used in both clinical practice and research and has been suggested as a useful screening tool for assessing the degree of cognitive impairment in the guidelines for the Report of the Quality Standards Subcommittee of the American Academy of Neurology.

Detection of memory impairment in the general population: screening by questionnaire and telephone compared to subsequent face‐to‐face assessment

Development of efficient methods for identifying subjects with Mild Cognitive Impairment (MCI) from the general population is warranted, because these subjects represent an important group for (epidemiological) research purposes. (1) To describe a two-step population screening for identifying adults with MCI from the general population for research purposes, by questionnaire and telephone; (2) to compare screening by telephone (method 1) to a subsequent face-to-face assessment (method 2). In method 1, subjects with memory complaints were identified from the general population (n = 5491) by a postal questionnaire. Subsequently, cognitive status and memory were assessed in a telephone interview using the Telephone Interview for Cognitive Status and the Ten Word Learning Test. Next, subjects with MCI according to method 1 were subjected to a face-to-face assessment for method 2, in which cognitive status and memory were assessed using the Mini Mental State Examination (MMSE) and the Auditory Verbal Learning Test (AVLT). Two hundred and twenty-seven subjects completed both the telephone interview and the face-to-face assessment. Ninety-three subjects (41%) had MCI according to both methods. Seven subjects (3%) failed to meet MCI criteria according to method two because of an MMSE score <24; 127 subjects (56%) failed because of normal AVLT scores. (1) The two-step population screening was able to detect a considerable number of MCI-subjects in the general population; (2) agreement between both methods was moderate. Therefore, the method of recruiting subjects for (epidemiological) studies has to be taken into consideration when interpreting results of these studies.

Implementing Diagnostic Criteria and Estimating Frequency of Mild Cognitive Impairment in an Urban Community

Reported rates of mild cognitive impairment (MCI) range widely depending on methodologic differences, including specific sample characteristics, cognitive measures used, normative samples used for neuropsychological tests, and diagnostic criteria. To operationalize diagnostic criteria for MCI and examine the frequency of MCI in ethnically and linguistically diverse elders (individuals older than 65 years). Prospective, community-based longitudinal cohort study. Northern Manhattan, New York, NY. A cohort of 1315 nondemented elderly participants. A diagnosis of MCI was assigned retrospectively on the basis of comprehensive neuropsychological, functional, and neurologic assessments. Amnestic MCI, as well as forms of mild impairment with other cognitive characteristics, were classified. The frequency of amnestic MCI was 5.0% (95% confidence interval, 3.8-6.2). Other subtypes of MCI ranged in frequency from 2.1% to 6.2%. Mild cognitive impairment was more common among those older than 75 years compared with those aged 65 to 75 years. Individuals with fewer than 9 years of schooling were more likely to meet MCI criteria. Apolipoprotein (APOE) E4 allele was more frequent among those with amnestic MCI. When proper normative values are used, only age and education, and not race or ethnicity, are associated with higher frequency of MCI. The proportion of nondemented elders with isolated memory deficits is smaller than the proportion with deficits in multiple cognitive domains. The strong association of the APOE E4 allele with only amnestic MCI suggests that there are likely to be multiple causes of cognitive impairment and differential rates of conversion to Alzheimer disease within the cognitive subtypes of MCI.

Current Epidemiology of Mild Cognitive Impairment and Other Predementia Syndromes

A variety of clinically-defined predementia syndromes, with differing diagnostic criteria and nomenclature, have been proposed to describe nondisabling symptomatic cognitive deficits arising in elderly persons. Incidence and prevalence of different predementia syndromes vary as a result of different diagnostic criteria, sampling, and assessment procedures. The incidence rates of all predementia syndromes increase with age and are higher in subjects with less education; but age, educational background, and gender are not consistently related to prevalence rates. There is particular interest in "Mild Cognitive Impairment (MCI)" because this predementia syndrome is thought to be a prodromal phase of Alzheimer disease (AD). Several studies have suggested that most patients who meet MCI criteria will progress to AD, but rates of conversion to AD and dementia vary widely among studies. Furthermore, MCI definition is less consistent in population-based studies than clinical studies, in which progression to AD is also more consistent. To clarify the sources of discrepant findings in the literature, this review summarizes existing epidemiological studies of the defined clinical predementia syndromes and their progression to dementia.

Mild Cognitive Impairment: An Operational Definition and Its Conversion Rate to Alzheimer’s Disease

Objective: Because of discrepant findings regarding the accuracy of mild cognitive impairment (MCI) in predicting Alzheimer’s disease (AD), further study of this construct and conversion rates is essential before use in clinical settings. We aimed to develop an operational definition of MCI consistent with criteria proposed by the Mayo Alzheimer’s Disease Center, and to examine its conversion rate to AD. Methods: Patients were identified from an inception cohort of patients with at least a 3-month history of memory problems, and referred to a 2-year university teaching hospital investigation by primary care physicians. We classified 161 nondemented patients at baseline using MCI criteria. Diagnostic workups were completed annually, and patients were classified as meeting criteria for AD or showing no evidence of dementia after 1 and 2 years. Results: Of 161 patients, 35% met MCI criteria at baseline. Conversion rates to AD were 41% after 1 year, and 64% after 2 years. Logistic regression analyses to examine predictive accuracy of MCI after 1 and 2 years, with age and education as covariates, were significant (p < 0.0001). After 1 year, MCI showed an optimal sensitivity of 91% and specificity of 79%, and after 2 years, these values were 88 and 83%, respectively. Conclusions: MCI is an accurate predictor of AD over 1 and 2 years in patients referred by their primary care physicians. Discrepancies in conversion rates may be due to the manner in which patients are recruited to studies as well as the use of different measures to operationalize the construct.

The development of performance and cost indicators for preschool immunisation.

The organisation, premises, and staffing of three child health clinics of different types in an inner city area have been studied and related to information on immunisation derived from their computerised child register and other returns, together with some simple estimates of cost. Differences were found between overall uptake of different antigens, consent rate, compliance after consent had been given, and the median age at immunisation for children allocated to each clinic. Thus consent to pertussis immunisation varied from 90% in one clinic to 69% in the other two. In the clinic with the high consent rate, however, only 66% of those whose parents had consented actually received all three doses compared with 82% and 85% in the other clinics. The median age of immunisation also showed pronounced differences between the clinics--314, 351, and 375 days, respectively, for the third dose of the triple course. There were differences in characteristics of the clientele served by each clinic and in staffing and facilities, which led to differences in costs, as well as contributing towards the variable patterns of uptake. We suggest that indicators such as these, largely available from the child health computer system, are used systematically to identify ways of improving uptake and increasing cost effectiveness.