Article Figures & Data
Figures
- Figure 1
Sampling frame and sample.
- Figure 2
Definitions and prevalences of MCI courses.
- Figure 3
First 3 nodes of the optimal tree found by CART analysis.
Tables
Characteristic Included Patients Excluded Patients P Value Number 357 126 Age, mean (SD), y 79.9 (3.8) 80.4 (4.1) .24 Female sex, No. (%) 234 (65.5) 88 (69.8) .38 Education level (CASMIN), % .02 Low 40.1 51.6 Medium 44.3 38.9 High 15.7 9.5 SIDAM score, mean (SD) 44.8 (5.2) 43.3 (4.9) .006 Global Deterioration Scale cognitive impairment, % .18 No 24.4 16.7 Questionable 29.4 30.2 Little 46.2 53.2 Mini-Mental State Examination score, mean (SD) 26.1 (2.2) 25.8 (2.1) .25 ApoE ε4 carrier, % 27.1 20.3 .14 MCI subtype by Winblad et al3, No. (%) .18 Nonamnestic single domain 217 (60.8) 64 (50.8) Amnestic single domain 46 (12.9) 19 (15.1) Nonamnestic multidomain 38 (10.6) 21 (16.7) Amnestic multidomain 56 (15.7) 22 (17.5) -
ApoE ε4 = apolipoprotein E ε4 allele; CASMIN = Comparative Analysis of Social Mobility in Industrial Nations; MCI = mild cognitive impairment; SIDAM = Structured Interview for Diagnosis of Dementia of Alzheimer type, Multi-infarct Dementia, and Dementia of other Aetiology according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised (DSM-III-R), Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and International Classification of Diseases, 10th Revision (ICD-10).
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Variable Odds Ratio 95% CI P Value Lower score in CERAD word list delayed recalla 1.20 1.047–1.372 <.0001 Depression (higher score on the Geriatric Depression Scale) 1.24 1.134–1.359 <.0001 MCI subtype .001 Nonamnestic single domain Ref – Amnestic single domain 1.42 0.715–2.820 Amnestic multidomain 3.38 1.772–6.429 Nonamnestic multidomain 2.30 1.148–4.599 Poorer test result in CERAD word list memory 1.10 1.018–1.183 .004 Older age in years 1.06 1.002–1.128 .04 -
CERAD = Neuropsychological battery of the Consortium to Establish a Registry for Alzheimer’s Disease; Ref = reference group; MCI = mild cognitive impairment.
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Note: MCI courses in order of increasing severity were remittent, fluctuating, stable, and progressive.
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↵a The higher the score, the better the recall function.
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The Article in Brief
Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study
Marion Eisele , and colleagues
Background Mild cognitive impairment, a transitional state between normal and illness-related cognitive decline, is a common condition in the elderly. As part of the German Study on Aging, Cognition and Dementia in Primary Care Patients, this study investigated determinants of the course of mild cognitive impairment (MCI) in primary care patients.
What This Study Found Among 357 primary care patients aged 75 years or older with a diagnosis of MCI without dementia, 42% had a remittent course (remission of symptoms and normal cognitive function at 1.5 and 3 years later) 21% had a fluctuating course (status changed between MCI and normal cognitive function), 15% had a stable course (impairment neither worsened to dementia nor improved to normal cognitive function), and 22% had a progressive course (developed to dementia). Patients were at higher risk of advancing from one course to the next along this spectrum if they had symptoms of depression, impairment in more than one cognitive domain, more severe cognitive impairment, and were older. Patients' performance on learning new material and the Geriatric Depression Scale helped predict a progressive versus a remittent course.
Implications
- In a 3-year period, about one-quarter of patients with MCI progress to dementia, while three-quarters of patients stay cognitively stable or improve. As a result, the authors suggest that patients should not be alarmed unnecessarily by a diagnosis of MCI.
