TY - JOUR T1 - Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study JF - The Annals of Family Medicine JO - Ann Fam Med SP - 158 LP - 165 DO - 10.1370/afm.1596 VL - 12 IS - 2 AU - Hanna Kaduszkiewicz AU - Marion Eisele AU - Birgitt Wiese AU - Jana Prokein AU - Melanie Luppa AU - Tobias Luck AU - Frank Jessen AU - Horst Bickel AU - Edelgard Mösch AU - Michael Pentzek AU - Angela Fuchs AU - Sandra Eifflaender-Gorfer AU - Siegfried Weyerer AU - Hans-Helmut König AU - Christian Brettschneider AU - Hendrik van den Bussche AU - Wolfgang Maier AU - Martin Scherer AU - Steffi G. Riedel-Heller AU - The Study on Aging, Cognition, and Dementia in Primary Care Patients (AgeCoDe) Study Group Y1 - 2014/03/01 UR - http://www.annfammed.org/content/12/2/158.abstract N2 - PURPOSE The 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). METHODS We 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. CONCLUSIONS In 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, DSM-5), 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. ER -