Outcome Of Mild Cognitive Impairment Research Articles

Mild cognitive impairment and dementia in primary care: the value of medical history

Primary care should be the place for the early detection of mild cognitive impairment (MCI) and dementia; however, a considerable proportion of these processes remain undetected at this setting. Family doctors may not have enough time or expertise for cognitive testing. The utility of clinical variables, other than cognitive tests, has hardly been investigated. To explore the diagnostic and prognostic value of the variables that are usually collected in the medical history of patients with suspected cognitive impairment. In this cohort study, people aged ≥ 50 years were prospectively searched for cognitive decline of unknown aetiology by seven primary care physicians (PCP) during their practice. The baseline assessment included demographic variables, symptom-related variables, medical and psychiatric co-morbidity, family history of dementia and neurological exam. The diagnosis was made by a neurologist at baseline and after 1 year. One hundred and seventy-six patients were analysed of whom 81 (46.0%) had MCI and 18 (10.2%) had dementia at baseline. After 1 year, 8 (9.9%) MCI patients had progressed to dementia, but 48 (59.3%) had reverted to normal cognition. Old age, source of symptoms (informant or PCP), short duration and low education were associated with MCI or dementia at baseline; low education predicted progression to dementia in MCI patients and less chronic medical conditions and younger age predicted reversion from MCI to normal cognition (P < 0.05, adjusted regression models). Clinical data usually collected on medical history by PCP are useful to detect patients with MCI and dementia and also to predict MCI outcome.

Multi-state Markov model in expressing the outcome of mild cognitive impairment among community-based elderly residents

To introduce the Multi-state Markov model in studying the outcome prediction of mild cognitive impairment (MCI). Based on the intelligence quotient (IQ) changes that reflecting the trends in cognitive function in the patients under follow-up program, we constructed a four states model and used Multi-state Markov model to analyze the patients. Among 600 MCI patients, there were 174 (29.0%) males and 426 (71.0%) females, with age range of 65-90 years-old (average 69.7 ± 6.6). For univariate analysis, gender, age, education level, marital status, smoking, household income, cerebral hemorrhage, hypertension, high cholesterol, diabetes, LDL-C, SBP and DBP were found to be associated with cognitive function. For multivariate analysis, female, older age, cerebral hemorrhage and higher SBP were shown to be the risk factors for transition from the state of cognitive stability to the state of severe deterioration, and their coefficients were 0.762, 0.366, 0.885, and 0.069, respectively. Age (0.038) could influence the transition from the state of cognitive stability to slight deterioration. Higher education level was shown to be the protective factor for these transitions (-0.219 and -0.297). Transition intensity from the state of cognitive stability to the state of slight and severe deterioration was 1.2 times that of transition to the state of improving. Transition intensity from state of slight deterioration to cognitive stability was 11.4 times that of transition to severe deterioration. Multi-state Markov model was an effective tool in dealing with longitudinal data.

The Fate of the 0.5s: Predictors of 2-Year Outcome in Mild Cognitive Impairment

Impairments in executive cognition (EC) may be predictive of incident dementia in patients with mild cognitive impairment (MCI). The present study examined whether specific EC tests could predict which MCI individuals progress from a Clinical Dementia Rating (CDR) score of 0.5 to a score ≥1 over a 2-year period. Eighteen clinical and experimental EC measures were administered at baseline to 104 MCI patients (amnestic and non-amnestic, single- and multiple-domain) recruited from clinical and research settings. Demographic characteristics, screening cognitive measures and measures of everyday functioning at baseline were also considered as potential predictors. Over the 2-year period, 18% of the MCI individuals progressed to CDR ≥ 1, 73.1% remained stable (CDR = 0.5), and 4.5% reverted to normal (CDR = 0). Multiple-domain MCI participants had higher rates of progression to dementia than single-domain, but amnestic and non-amnestic MCIs had similar rates of conversion. Only three EC measures were predictive of subsequent cognitive and functional decline at the univariate level, but they failed to independently predict progression to dementia after adjusting for demographic, other cognitive characteristics, and measures of everyday functioning. Decline over 2 years was best predicted by informant ratings of subtle functional impairments and lower baseline scores on memory, category fluency, and constructional praxis.

Predicting outcome in mild cognitive impairment: 4-year follow-up study

Cognitive impairment precedes the diagnosis of Alzheimer's disease. It is unclear which psychometric measures predict dementia, and what cut-off points should be used. Replicable cognitive measures to provide information about differential diagnosis and prognosis would be clinically useful. In a prospective cohort study we investigated which measures distinguish between individuals with amnestic mild cognitive impairment (aMCI) that converts to dementia and those whose impairment does not, and which combination of measures best predicts the fate of people with aMCI. Forty-four participants with aMCI underwent extensive neuropsychological assessment at baseline and annually thereafter for an average of 4 years. Differences in baseline cognitive performance of participants who were converters and non-converters to clinically diagnosed dementia were analysed. Classification accuracy was estimated by sensitivity, specificity, positive and negative predictive values and using logistic regression. Forty-one percent of participants had progressed to dementia by the end of study, with a mean annual conversion rate of 11%. Most (63%) showed persisting or progressive cognitive impairment, irrespective of diagnosis. The Addenbrooke's Cognitive Examination together with the discrimination index of the Hopkins Verbal Learning Test - Revised (but none of the demographic indices) differentiated the participants who were converters from the non-converters at baseline with 74% accuracy. Targeted neuropsychological assessment, beyond simple cognitive screening, could be used in clinical practice to provide individuals with aMCI with prognostic information and aid selective early initiation of monitoring and treatment among those who progress towards a clinically diagnosable dementia.

Depressive signs in midlife: A risk factor for cognitive impairment in later life?

Background: Although depression has been associated with dementia, the nature of this relation is still unclear. Establishing causality from previous studies has been complicated by the typical use of a short follow-up and participants aged over 70 already at baseline. The main purpose of this study was to evaluate if depressive signs already in midlife are related to cognitive impairment in later life. Methods: Participants were derived from random, population-based samples previously investigated in 1972, 1977, 1982, or 1987. Their mean age at baseline was 50.4 years (SD 6.0). After an average follow-up of 21 years, 1449 individuals (73%) aged 65 to 79 years were re-examined in 1998. At the re-examination some form of cognitive impairment was diagnosed in 139 of the participants: 82 with mild cognitive impairment and 57 with dementia (48 of these with Alzheimer’s disease). Signs of depression were estimated through responses to three questions concerning the perception of a hopeless future, impossible life goals and loneliness. The relation between depressive signs in midlife and cognitive impairment in later life was analyzed with logistic regression with adjustments for age, gender, apolipoprotein e4 status and a number of midlife health and lifestyle indicators, including blood pressure, cholesterol and marital status. Results: Depressive signs in midlife, as measured in this study, were significantly related to general cognitive impairment in later life, but also separately to both mild cognitive impairment and Alzheimer’s disease. When dichotomized into high versus low levels of depressive signs the odds ratios were 2.19 (1.1 to 4.3) for mild cognitive impairment and 3.81 (1.3 to 11.5) for Alzheimer’s disease. Significant associations were also found between the separate measures of hopelessness and loneliness on the one hand and the separate outcomes of mild cognitive impairment and Alzheimer’s disease on the other. Conclusions: The results support a causal relation between depressive signs relatively early in life and cognitive function in later life. Clinical relevance includes the long-term health implications of depressive signs in midlife also for the risk of dementia.

Cerebrospinal Fluid Biomarkers and Prediction of Conversion in Patients with Mild Cognitive Impairment: 4-Year Follow-Up in a Routine Clinical Setting

Mild cognitive impairment (MCI) is a very common syndrome in elderly people, with a high risk of conversion to dementia. Several investigations have shown the usefulness of cerebrospinal fluid (CSF) biomarkers (Aβ42, total tau [T-tau], and phosphorylated tau [P-tau]) in predicting the progression to Alzheimer's disease (AD). We report a 4-year follow-up of MCI patients who underwent CSF evaluation for biomarker assessment, in order to further evaluate the usefulness of CSF analysis in predicting the conversion to dementia in a routine clinical setting. We identified 55 patients with MCI among the consecutive patients, referred from 2001 to 2003 to our Memory Clinic for cognitive disorders, who underwent a complete diagnostic assessment, including lumbar puncture (n = 273). At the end of the follow-up, 31 MCI patients (56%) did not progress to dementia (stable MCI), while 24 (44%) developed a dementia condition. At baseline, the mean levels of CSF Aβ42, T-tau, and P-tau were significantly altered in MCI patients who were converting to dementia with respect to those with stable MCI. All MCI patients with the three altered CSF biomarkers developed dementia within 1 year. Among the stable MCI patients, none showed all three pathological values and only one subject had the pathological value of P-tau. Early diagnosis of dementia and, specifically, a correct prediction of MCI outcome represent a primary goal. To this respect, the role of CSF biomarkers seems to be crucial in a routine clinical setting.

Cognitive Dysfunction in an Urban Indian Population – Some Observations

There is no prospective study of mild cognitive impairment (MCI) in India. This study aims to determine the prevalence rate of dementia and to prospectively analyze a group of patients with MCI. A door-to-door cross-sectional cluster survey was conducted in Kolkata, India, among those aged >50 years to estimate the prevalence rate of dementia. Then annual assessment of cognitive function using a validated questionnaire battery was undertaken among 21 elderly individuals with memory complaints for 4 consecutive years. A total of 53,907 persons were surveyed. The crude prevalence rates of dementia were 0.62% (95% CI 0.44–0.84) and 1.25% (95% CI 0.87–1.74) among those >50 and >60 years of age, respectively. The weighted prevalence rate among those above 50 years was 0.95% (95% CI 0.68–1.29). Alzheimer’s disease was the commonest subtype (55%) followed by vascular dementia (36%). In a prospective study, MCI remained static, converted to dementia or reverted to normalcy. There was also transition from one subtype of MCI to another. A similar outcome of MCI is also noted in Western nations. However, the prevalence rate of dementia in Eastern India remained quite low.

Plasmatic level of neurosin predicts outcome of mild cognitive impairment

BackgroundMild Cognitive Impairment (MCI) is a disorder considered to be a transitional stage from health to dementia. Diagnosis of dementias at these early stages is always troublesome because the pathophysiologic events leading to dementia precede clinical symptoms. Thus, the development of biomarkers that can be used to support the diagnosis of dementias at early stages is rapidly becoming a high priority. We have recently reported the value of measuring plasmatic levels of neurosin in the diagnosis of Alzheimer's disease (AD). The aim of this study is to determine whether measuring plasmatic concentration of neurosin is a valuable test to predict progression of MCI.MethodsPlasmatic neurosin concentrations were measured in 68 MCI patients and 70 controls subjects. Blood samples were obtained at the beginning of the study. Sixty six patients diagnosed with MCI were observed for 18 months. In 36 patients a second blood sample was obtained at the endpoint.ResultsThe mean value of plasmatic neurosin concentration differs significantly between MCI patients who converted to Dementia with vascular component, those who converted to AD, or those who remained at MCI stage. The relative risk of developing Dementia with vascular component when neurosin levels are higher than 5.25 ng/ml is 13 while the relative risk of developing mild AD when neurosin levels are lower than 5.25 ng/ml is 2. Increases in the levels of neurosin indicate progression to Dementia with vascular component.ConclusionThe measurement of plasmatic neurosin level in patients diagnosed with MCI may predict conversion from MCI to Dementia with vascular component. A single measurement is also valuable to estimate the risk of developing AD and Dementia with vascular component. Finally, repeated measurement of plasmatic neurosin might be a useful test to predict outcome in patients with MCI.

Imaging of mild cognitive impairment and early dementia

The concept of mild cognitive impairment (MCI) has been introduced to describe older individuals who cognitively lie between normal ageing and dementia. Nowadays, there is a particular interest in MCI because this syndrome is thought to be a transitional stage to Alzheimer's disease (AD) that may define a window for effective therapeutic interventions. However, not all patients with MCI will go on to develop AD. Imaging offers an extraordinary opportunity to study MCI. We will review key findings of brain imaging studies in MCI, including structural brain changes studied with MRI, white matter changes with diffusion tensor imaging and altered brain activity and blood flow studied with various imaging modalities, such as positron emission tomography, single-photon emission computed tomography and arterial spin labelling MRI, a non-invasive approach to measure cerebral blood flow. The strength and limitations of each modality for diagnosis of MCI, prediction of MCI outcome and assessment of drug efficacy will be discussed.

Neuropathologic Outcome of Mild Cognitive Impairment Following Progression to Clinical Dementia

Neuropathologic Outcome of Mild Cognitive Impairment Following Progression to Clinical Dementia

Outcome and cognitive changes of mild cognitive impairment in the elderly: a follow-up study of 47 cases

To examine the cognitive changes and outcome of mild cognitive impairment (MCI) in the elderly and to explore the predictive factors of development from MCI into dementia. A cross-sectional and longitudinal parallel cohort study design was conducted among 47 patients with MCI (MCI group), aged 72.4 +/- 7.1, and 50 sex, marital status, and professional structure-matched normal controls (NC group), aged 67.9 +/- 5.3, using the Neuropsychological Battery of Cognitive Assessment Instruments developed by World Health Organization (WHO-BCAI) and the Wechsler Memory Scale (WMS) to assess the cognitive function. Follow-up was conducted for 34.0 +/- 1.8 months. The diagnosis of dementia was based on the criteria in the Diagnostic and Statistical Manual-IV. Dementia was diagnosed in 13 of the 47 MCI patients with a prevalence rate of 27.7%, significantly higher than that in the NC group (2.0%, 1/50, P < 0.01). The mean total score of mini-mental status examination (MMSE) of the MCI group decreased by 2.2 +/- 3.7, significantly more than that of the NC group (1.0 +/- 1.9, P < 0.01). The mean total mental quotient (MQ) of the MCI group decreased by 12.6 +/- 17.3, significantly more than that of the NC group (3.9 +/- 8.4, P < 0.01). The values of MMSE and MQ of the 13 cases in the MCI group who developed into dementia patients decreased by 5.5 +/- 2.8 and 30.0 +/- 18.0 respectively. The WHO-BCAI assessment demonstrated that the scores of performance of verbal learning, verbal fluency, visual reasoning, trail making, sorting and spatial construct tests of the cases in the MCI group who developed into dementia patients were significantly poorer than those of the NC group (P < 0.01). Logistic analysis based on the baseline assessment suggested that the total score of MMSE and its subtest of orientation, score of orientation memory of WMS, and the scores of performance of trail making, attention, and delayed recall tested by WHO-BCAI were all statistically significant predictive factors for MCI converting into dementia (P < 0.01 or 0.05). The predictive accuracy rates of MMSE, WMS, and WHO-BCAI were 70.3%, 78.4% and 90.7% respectively. MCI diagnosed based on the criteria of pure MCI modified by the authors is indeed a transitional state from normal aging to dementia, especially Alzheimer's type of dementia. The cognitive change for MCI converting into dementia is characterized in the areas of orientation, attention, speech and executive function. These predictive factors for MCI to develop dementia are valuable in early detection and prevention of dementia in the elderly.

Neuropathologic Outcome of Mild Cognitive Impairment Following Progression to Clinical Dementia

The pathologic outcome of patients diagnosed with mild cognitive impairment (MCI) following progression to dementia is poorly understood. To determine the pathologic substrates of dementia in cases with prior diagnosis of amnestic MCI. Community-based cohort. Thirty-four subjects followed up prospectively as part of a community-based study who were diagnosed with amnestic MCI, progressed to clinical dementia, and underwent subsequent postmortem brain analysis. Neuropathologic analyses resulted in assignment of a primary pathologic diagnosis and included staging of Alzheimer pathologic abnormalities and identification of contributing vascular disease, Lewy bodies, and argyrophilic grains. Although the majority of subjects progressed both clinically and pathologically to Alzheimer disease (AD), 10 (29%) of them developed non-AD primary pathologic abnormalities. All of the cases were found to have sufficient pathologic abnormalities in mesial temporal lobe structures to account for their amnestic symptoms regardless of the cause. Most subjects were found to have secondary contributing pathologic abnormalities in addition to primary pathologic diagnoses. No significant differences between subjects with and without neuropathologically proven AD were detected in demographic variables, apolipoprotein E genotype, or cognitive test measures at onset of MCI, onset of dementia, or last clinical evaluation. The neuropathologic outcome of amnestic MCI following progression to dementia is heterogeneous, and it includes AD at a high frequency. Complex neuropathologic findings including 2 or more distinct pathologic entities contributing to dementia may be common in community-based cohorts. Neither demographic variables nor cognitive measures had predictive value in determining which patients diagnosed with MCI will develop the neuropathologic features of AD.

P1-140 Neuropathological outcome of mild cognitive impairment following progression to clinical dementia

P1-140 Neuropathological outcome of mild cognitive impairment following progression to clinical dementia

P1-024 Residential outcomes in mild cognitive impairment

P1-024 Residential outcomes in mild cognitive impairment

Variations in case definition affect prevalence but not outcomes of mild cognitive impairment.

To examine the prevalence estimates and 5-year outcomes of various case definitions of mild cognitive impairment (MCI). The authors examined 1,790 adults 65 years of age or older who completed neuropsychological and clinical assessments in the Canadian Study of Health and Aging, a 5-year, representative, prospective cohort study. The most commonly used case definition of MCI yielded a population prevalence estimate of 1.03% (95% CI 0.66 to 1.40). Eliminating the requirements for subjective memory complaints and intact instrumental activities of daily living (IADL) increased the prevalence to 3.02% (CI 2.40 to 3.64). Five-year outcomes, including the risk of death, institutionalization, and dementia, were not distinctly different for various case definitions of MCI, but all were at increased risk of institutionalization (RR 2.3 to 5.2) and dementia (RR 9.3 to 19.7). Regardless of the case definition, most people with MCI developed dementia, chiefly Alzheimer disease (AD). Still, for each case definition, almost one third were considered to have no cognitive impairment after 5 years. Memory complaints and intact IADL may be unnecessary requirements for a case definition of MCI in population-based samples. The MCI criteria identify people at increased risk of AD, but the potential for improvement of a substantial proportion of those with MCI needs to be acknowledged.

Incidence and outcome of mild cognitive impairment in a population-based prospective cohort.

To estimate the age-specific incidence rate of mild cognitive impairment (MCI) according to sex and educational level and to explore the course of MCI, particularly its progression to AD, in a population-based cohort. A community-based cohort of nondemented elderly people (Personnes Agées QUID [PAQUID]) was followed longitudinally for 5 years. MCI was defined as memory complaints with objective memory impairment, without dementia, impairment of general cognitive functioning, or disability in activities of daily living. Incidence rates were calculated using the person-years method. A descriptive analysis at the different follow-up times was performed to study the course of MCI. At baseline, there were 58 prevalent cases of MCI (2.8% of the sample). During a 5-year follow-up, 40 incident cases of MCI occurred in 1,265 subjects at risk. The global incidence rate of MCI was 9.9/1,000 person-years. MCI was a good predictor of AD with an annual conversion rate of 8.3% and a good specificity, but it was very unstable over time: Within 2 to 3 years, only 6% of the subjects continued to have MCI, whereas >40% reverted to normal. Conventionally defined MCI has reasonable predictive value and specificity for AD. However, MCI was very unstable across time in this study. Furthermore, the definition of MCI seems to be too restrictive and should probably be extended to other categories of individuals also at high risk of developing AD.

Compelling evidence for discretionary brain computed tomographic imaging in those patients with mild cognitive impairment after blunt trauma.

To identify computed tomographic-detected intracranial hemorrhage (CTIH) risk factors and outcome in mild cognitive impairment (MCI) blunt trauma patients. In 2,587 consecutive patients, 251 (9.7%) had CTIH. Analysis is on 2,252 direct transports with 163 CTIH, because transfers were different (7.2 vs. 26.3%, p < 0.0001). CTIH rates for patients age 14-60 and > 60 years were 6.3 and 15.9%, p = 0.001. In those 14-60 years (n = 2,032), CTIH (n = 128) was independently related to arrival Glasgow Coma Scale (GCS) score and cranial soft tissue injury (CSTI) (p = 0.0001). [table: see text] Craniotomy was < or = 0.6% in each group except GCS score of 13 with CSTI, 7.4%. Of those with CTIH, 98.4% survived. Of those at low risk (GCS score of 14 without CSTI and GCS score of 15), 1,504 had no CTIH. Of these, 64.4% were available for serial cognitive evaluation (noncranial injuries mandated hospitalization; tracheal intubation was not required). In those > 60 years (n = 220), CTIH (n = 35) was independently related to GCS and CSTI (p = 0.003). CTIH for GCS score of 15 without CSTI was 5.8%, but > or = 16% for others. One craniotomy was required. Of those with CTIH, 91.4% survived. In mild cognitive impairment patients triaged directly to a Level I trauma center, age, arrival GCS score, and cranial soft tissue injury are risk factors for CT-detected intracranial hemorrhage. Neurologic deterioration and death are infrequent. These data strongly suggest that observation and discretionary brain CT imaging are a rational approach for blunt-injury mild cognitive impairment.

Definition, course, and outcome of mild cognitive impairment

Abstract Mild Cognitive Impairment (MCI) is a term which can be applied to a boundary area between dementia and normal aging. Criteria which reliably describe persons falling in this range of the cognitive continuum can be defined. These persons are at very high risk for developing dementia. Biologic and cognitive parameters including Apolipoprotein E genotype help to differentiate MCI persons who will progress to dementia in 2-4 years from those who will remain free from dementia over this interval.