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. 2014 May;10(3):319-27.
doi: 10.1016/j.jalz.2013.02.007. Epub 2013 Jul 16.

The source of cognitive complaints predicts diagnostic conversion differentially among nondemented older adults

Katherine A Gifford  1 , Dandan Liu  2 , Zengqi Lu  2 , Yorghos Tripodis  3 , Nicole G Cantwell  4 , Joseph Palmisano  5 , Neil Kowall  6 , Angela L Jefferson  7
Affiliations

The source of cognitive complaints predicts diagnostic conversion differentially among nondemented older adults

Katherine A Gifford et al. Alzheimers Dement. 2014 May.

Abstract

Objective: The objective of this study was to compare whether different sources of cognitive complaint (i.e., subjective and informant) predict diagnostic conversion in nondemented older adults.

Methods: Participants from the National Alzheimer's Coordinating Center had a baseline diagnosis of normal cognition (NC; n = 4414; mean age, 73 ± 8 years; 69% female) or mild cognitive impairment (MCI; n = 1843; mean age, 74 ± 8 years; 52% female). Multinomial logistic regression related baseline cognitive complaint (no complaint, self only, informant only, or both self and informant) to diagnostic outcome (reversion, stable, or conversion).

Results: At follow-up, 14% of NC participants converted to MCI/dementia (3.5 ± 1.8 years), and 41% of MCI participants converted to dementia (3.0 ± 1.6 years). Among NC participants, self complaint only (odds ratio [OR], 2.1; 99% confidence interval (CI),1.5-2.9; P < .001), informant complaint only (OR, 2.2; 99% CI, 1.2-3.9; P < .001), and both self and informant complaint (OR, 4.2; 99% CI, 2.9-6.0; P < .001) were associated with diagnostic conversion compared with no complaint. Among participants with MCI-compared with no complaint, informant complaint only (OR, 2.2; 99% CI, 1.2-4.3, P = .002), and both self and informant complaint (OR, 2.9; 99% CI, 1.8-4.8; P < .001)-were associated with conversion.

Conclusions: Cognitive complaints are related to conversion among nondemented older adults. Complaint from both (i.e. mutual complaint) sources was most predictive of diagnostic outcome, followed by informant complaint, highlighting the need for obtaining informant corroboration to enhance prognosis and distinguish underlying pathological processes from normal cognitive aging. Self complaint was related inconsistently to diagnostic outcome.

Keywords: Alzheimer’s disease; Cognitive complaints; Conversion; Mild cognitive impairment; Prognosis.

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Figures

Figure 1
Figure 1. Participant Enrollment & Exclusion Details
Note: The exclusion numbers provided are not mutually exclusive. Missing data include complaint status at baseline. Cognitively impaired patients without MCI were excluded because of nonstandardized classification criteria. NACC UDS, National Alzheimer’s Coordinating Center Uniform Data Set; MCI, mild cognitive impairment, TIA, transient ischemic attack.
Figure 2
Figure 2
depicts the predicted probability of diagnostic outcome for each cognitive complaint group by age. Figure 2a reflects the likelihood of conversion in individuals with normal cognition. Figure 2b reflects the likelihood of conversion in individuals with MCI as compared to remaining diagnostically stable. Figure 2c reflects the likelihood of reversion in individuals with MCI as compared to remaining diagnostically stable.
See this image and copyright information in PMC

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