Progression of mild cognitive impairment to dementia: a challenge to current thinking

Busse, Anja; Angermeyer, Matthias C.; Riedel‐Heller, Steffi G.

doi:10.1192/bjp.bp.105.014779

Cited by 137 publications

(85 citation statements)

References 18 publications

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“…3 Furthermore, progression to dementia seems to occur primarily within the first months of observation with lower rates in later years. 22,27 Our conversion rate of 22.4% in patients with a mean age of 79.9 ± 3.8 years lies between the 6.6% found in a considerably younger sample (74.6 ± 5.7 years) 21 and the 30% found in an older sample (82.2 ± 5.0 years). 22 This pattern underlines earlier findings of an increased risk for progression to dementia in older age.…”

Section: Progressive Coursementioning

confidence: 86%

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Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study

Kaduszkiewicz

Eisele

Wiese

et al. 2014

The Annals of Family Medicine

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PURPOSEThe concept of mild cognitive impairment (MCI) has recently been introduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as mild neurocognitive disorder, making it a formal diagnosis. We investigated the prognostic value of such a diagnosis and analyzed the determinants of the future course of MCI in the AgeCoDe study (German Study on Ageing, Cognition, and Dementia in Primary Care Patients). METHODSWe recruited 357 patients with MCI aged 75 years or older from primary care practices and conducted follow-up with interviews for 3 years. Depending on the course of impairment over time, the patients were retrospectively split into 4 groups representing remittent, fluctuating, stable, and progressive courses of MCI. We performed ordinal logistic regression analysis and classification and regression tree (CART) analysis.RESULTS Overall, 41.5% of the patients had remission of symptoms with normal cognitive function 1.5 and 3 years later, 21.3% showed a fluctuating course, 14.8% had stable symptoms, and 22.4% had progression to dementia. Patients were at higher risk for advancing from one course to the next along this spectrum if they had symptoms of depression, impairment in more than 1 cognitive domain, or more severe cognitive impairment, or were older. The result on a test of the ability to learn and reproduce new material 10 minutes later was the best indicator at baseline for differentiating between remittent and progressive MCI. Symptoms of depression modified the prognosis. CONCLUSIONSIn primary care, about one-quarter of patients with MCI have progression to dementia within the next 3 years. Assessments of memory function and depressive symptoms are helpful in predicting a progressive vs a remittent course. When transferring the concept of MCI into clinical diagnostic algorithms (eg,, however, we should not forget that three-quarters of patients with MCI stayed cognitively stable or even improved within 3 years. They should not be alarmed unnecessarily by receiving such a diagnosis. 2014;158-165. doi:10.1370/afm.1596. Ann Fam Med INTRODUCTION Mild cognitive impairment (MCI) is a common condition in the elderly with a prevalence of 16.0% in individuals without dementia 1 and an incidence rate of 63.6 (per 1,000 person-years). 2 It is considered to be a transitional state between normal and pathologic cognitive decline. MCI is defined by a cognitive performance below that expected for age and educational attainment, but above a pathologic level as in early dementia. Patients show essentially normal functional activities.Winblad et al 3 classified the clinical presentations of MCI into subtypes according to the impaired cognitive domains, such as memory, orientation, intellectual abilities, and higher cortical functioning. Taking into account memory deficits and the number of cognitive domains impaired, MCI subtypes have been classified as follows: amnestic single domain (impairment of memory only), amnestic multidomain (impairment of memory and 1 or more o...

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Section: Progressive Coursementioning

confidence: 86%

“…[19][20][21][22][23] The overall rates in those studies varied between 0.7% 19 and 51.6%. 23 In the majority of studies, patients with multidomain MCI were at higher risk for progression than patients with single-domain subtypes, 20,[24][25][26] but results vary regarding the exact rank order of risk associated with the subtypes.…”

Section: Progressive Coursementioning

confidence: 99%

Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study

Kaduszkiewicz

Eisele

Wiese

et al. 2014

The Annals of Family Medicine

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“…Only two-thirds of people with MCI progress to dementia in their lifetime 99 , limiting the power of secondary prevention studies that recruit MCI populations. The heterogeneity and instability of the MCI diagnosis militate against finding positive results in MCI trials.…”

Section: Future Researchmentioning

confidence: 99%

Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Cooper¹,

Sommerlad²,

Lyketsos³

et al. 2015

AJP

439

314

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Objectives: Public health campaigns encouraging early help-seeking have increased rates of Mild Cognitive Impairment (MCI) diagnosis in Western countries, but we know little about how to treat or prognosticate dementia outcomes in persons with MCI. Method: We searched electronic databases and references for longitudinal studies reporting potentially modifiable risk factors for incident dementia after MCI. Two authors independently evaluated study quality using a checklist. We meta-analysed findings from three or more studies. Results: We identified 76 eligible papers. Diabetes and prediabetes increased risk of conversion from amnestic MCI (aMCI) to Alzheimer's Dementia (AD); risk in treated versus untreated diabetes was lower in one study. Diabetes was also associated with increased risk of conversion from any type or non-amnestic MCI to all cause dementia. Metabolic syndrome and pre-diabetes predicted all cause dementia in people with aMCI and any type MCI respectively. Mediterranean diet decreased risk of conversion from aMCI to AD. Presence of neuropsychiatric symptoms or lower serum folate levels predicted conversion from any type MCI to all cause dementia, but less formal education did not. Depressive symptoms predicted conversion from any type MCI to dementia in epidemiological, but not clinical studies. Conclusions: Diabetes increased the risk of conversion to dementia. Other prognostic factors that are potentially manageable are pre-diabetes and the metabolic syndrome, neuropsychiatric symptoms and low dietary folate. Dietary interventions and interventions to reduce neuropsychiatric symptoms including depression, which increase conversion risk to dementia, may decrease incident dementia.

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“…12,13 This research has given rise to the concept of MCI, which is the state between the cognitive changes of normal ageing and very early dementia. 14,15 The transitional period has been described using a variety of terms such as MCI, dementia prodrome, incipient dementia, isolated memory impairment 16 and, more recently, mild neurocognitive disorder. 12 For the purposes of this report, the term 'mild cognitive impairment' or MCI has been used.…”

Section: Mild Cognitive Impairmentmentioning

confidence: 99%

“…For example, guidelines suggest that the decision of whether or not to investigate for possible mild cognitive impairment or dementia is influenced by cognitive test scores (e.g. in the Mini-Mental State Examination, the threshold for mild Alzheimer's disease is a score of 21-26, whereas the threshold for moderate Alzheimer's disease is a score of [10][11][12][13][14][15][16][17][18][19][20].…”

Section: National Institute Of Neurological and Communicative Disordementioning

confidence: 99%

Automated tests for diagnosing and monitoring cognitive impairment: a diagnostic accuracy review

Aslam

Bates

Dündar

et al. 2016

Health Technol Assess

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BackgroundCognitive impairment is a growing public health concern, and is one of the most distinctive characteristics of all dementias. The timely recognition of dementia syndromes can be beneficial, as some causes of dementia are treatable and are fully or partially reversible. Several automated cognitive assessment tools for assessing mild cognitive impairment (MCI) and early dementia are now available. Proponents of these tests cite as benefits the tests’ repeatability and robustness and the saving of clinicians’ time. However, the use of these tools to diagnose and/or monitor progressive cognitive impairment or response to treatment has not yet been evaluated.ObjectivesThe aim of this review was to determine whether or not automated computerised tests could accurately identify patients with progressive cognitive impairment in MCI and dementia and, if so, to investigate their role in monitoring disease progression and/or response to treatment.Data sourcesFive electronic databases (MEDLINE, EMBASE, The Cochrane Library, ISI Web of Science and PsycINFO), plus ProQuest, were searched from 2005 to August 2015. The bibliographies of retrieved citations were also examined. Trial and research registers were searched for ongoing studies and reviews. A second search was run to identify individual test costs and acquisition costs for the various tools identified in the review.Review methodsTwo reviewers independently screened all titles and abstracts to identify potentially relevant studies for inclusion in the review. Full-text copies were assessed independently by two reviewers. Data were extracted and assessed for risk of bias by one reviewer and independently checked for accuracy by a second. The results of the data extraction and quality assessment for each study are presented in structured tables and as a narrative summary.ResultsThe electronic searching of databases, including ProQuest, resulted in 13,542 unique citations. The titles and abstracts of these were screened and 399 articles were shortlisted for full-text assessment. Sixteen studies were included in the diagnostic accuracy review. No studies were eligible for inclusion in the review of tools for monitoring progressive disease. Eleven automated computerised tests were assessed in the 16 included studies. The overall quality of the studies was good; however, the wide range of tests assessed and the non-standardised reporting of diagnostic accuracy outcomes meant that meaningful synthesis or statistical analysis was not possible.LimitationsThe main limitation of this review is the substantial heterogeneity of the tests assessed in the included studies. As a result, no meta-analyses could be undertaken.ConclusionThe quantity of information available is insufficient to be able to make recommendations on the clinical use of the computerised tests for diagnosing and monitoring MCI and early dementia progression. The value of these tests also depends on the costs of acquisition, training, administration and scoring.Future workResearch is required to establish stable cut-off points for automated computerised tests that are used to diagnose patients with MCI or early dementia. Additionally, the costs associated with acquiring and using these tests in clinical practice should be estimated.Study registrationThe study is registered as PROSPERO CRD42015025410.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Progression of mild cognitive impairment to dementia: a challenge to current thinking

Abstract: Further long-term studies are needed to examine the time-dependent evolution from mild cognitive impairment to dementia and to establish age-specific conversion rates during lifetime.

Cited by 137 publications

References 18 publications

Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study

Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study

Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Automated tests for diagnosing and monitoring cognitive impairment: a diagnostic accuracy review

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