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. 2013 Nov;9(6):632-9.
doi: 10.1016/j.jalz.2012.10.014. Epub 2013 Feb 27.

Course and etiology of dysexecutive MCI in a community sample

Edward D Huey  1 , Jennifer J Manly, Ming-X Tang, Nicole Schupf, Adam M Brickman, Masood Manoochehri, Jesse Mez, Charles DeCarli, Davangere P Devanand, Richard Mayeux
Affiliations

Course and etiology of dysexecutive MCI in a community sample

Edward D Huey et al. Alzheimers Dement. 2013 Nov.

Abstract

Background: Amnestic mild cognitive impairment (aMCI) is associated with an elevated risk of progressing to Alzheimer's disease. Much less is known about the course of dysexecutive mild cognitive impairment (dMCI). The goals of this study were to determine how the profile of cognitive deficits differs over time between patients with dMCI and aMCI, and control subjects; if the type of dementia differs between dMCI and aMCI in patients who progress to dementia; and if dMCI is more associated with stroke and white matter hyperintensity on magnetic resonance imaging (MRI) than aMCI.

Methods: The authors undertook a prospective evaluation of an inception cohort of 1167 ethnically diverse elders recruited from an urban community-based sample monitored with clinical and neuropsychological testing for an average of 4.5 years (standard deviation, 0.8 year). A subset of the subjects underwent MRI. We compared four groups of MCI patients: single-domain amnestic and dysexecutive MCI, and multiple-domain MCI with and without executive dysfunction.

Results: Compared with aMCI, dMCI was less likely to involve other areas of cognition over time and progress to dementia. None of the 33 single-domain dMCI patients progressed to dementia. The presence of executive dysfunction in multiple-domain MCI did not increase risk of progression to dementia. Patients with multiple-domain MCI with executive dysfunction who progressed to dementia were less likely to have an Alzheimer's-type dementia than MCI patients without executive dysfunction. Patients with dMCI were more likely to experience stroke, but not white matter hyperintensity, detected via MRI than patients with aMCI.

Conclusions: dMCI appears to follow a different course, and is less associated with Alzheimer's disease and more associated with stroke than aMCI.

Keywords: Dementia; Executive function; MRI; Mild cognitive impairment.

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Figures

Figure 1
Figure 1. Flow diagram of study enrollment
Figure 2
Figure 2. Cognitive changes over time
Changes in cognitive performance over time in different domains of cognition in patients with aMCI, dMCI, MCI-MCDE, MCI-MCDN, and patients without dementia or MCI. MCI=Mild Cognitive Impairment. aMCI-=Amnestic MCI, dMCI=Dysexecutive MCI, MCI-MCDE=Multidomain MCI with executive dysfunction. MCI-MCDN= Multidomain MCI without executive dysfunction. (a) Language factor score (b) Memory factor score (c) Executive function factor score (d) Visuospatial factor score
Figure 2
Figure 2. Cognitive changes over time
Changes in cognitive performance over time in different domains of cognition in patients with aMCI, dMCI, MCI-MCDE, MCI-MCDN, and patients without dementia or MCI. MCI=Mild Cognitive Impairment. aMCI-=Amnestic MCI, dMCI=Dysexecutive MCI, MCI-MCDE=Multidomain MCI with executive dysfunction. MCI-MCDN= Multidomain MCI without executive dysfunction. (a) Language factor score (b) Memory factor score (c) Executive function factor score (d) Visuospatial factor score
Figure 2
Figure 2. Cognitive changes over time
Changes in cognitive performance over time in different domains of cognition in patients with aMCI, dMCI, MCI-MCDE, MCI-MCDN, and patients without dementia or MCI. MCI=Mild Cognitive Impairment. aMCI-=Amnestic MCI, dMCI=Dysexecutive MCI, MCI-MCDE=Multidomain MCI with executive dysfunction. MCI-MCDN= Multidomain MCI without executive dysfunction. (a) Language factor score (b) Memory factor score (c) Executive function factor score (d) Visuospatial factor score
Figure 2
Figure 2. Cognitive changes over time
Changes in cognitive performance over time in different domains of cognition in patients with aMCI, dMCI, MCI-MCDE, MCI-MCDN, and patients without dementia or MCI. MCI=Mild Cognitive Impairment. aMCI-=Amnestic MCI, dMCI=Dysexecutive MCI, MCI-MCDE=Multidomain MCI with executive dysfunction. MCI-MCDN= Multidomain MCI without executive dysfunction. (a) Language factor score (b) Memory factor score (c) Executive function factor score (d) Visuospatial factor score
Figure 3
Figure 3. Survival curve
Survival curve for development of dementia in patients with aMCI, dMCI, MCI-MCDE, MCI-MCDN, and patients without dementia or MCI.
Figure 4
Figure 4. Number of infarcts
Differences in mean (SE) number of infarcts as a function of diagnostic group. Lines show groups that are significantly different from each other (p<0.05)
See this image and copyright information in PMC

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