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. 2014 Jan 28;82(4):317-25.
doi: 10.1212/WNL.0000000000000055. Epub 2013 Dec 18.

Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal

Rosebud O Roberts  1 , David S Knopman, Michelle M Mielke, Ruth H Cha, V Shane Pankratz, Teresa J H Christianson, Yonas E Geda, Bradley F Boeve, Robert J Ivnik, Eric G Tangalos, Walter A Rocca, Ronald C Petersen
Affiliations

Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal

Rosebud O Roberts et al. Neurology. .

Abstract

Objective: To estimate rates of progression from mild cognitive impairment (MCI) to dementia and of reversion from MCI to being cognitively normal (CN) in a population-based cohort.

Methods: Participants (n = 534, aged 70 years and older) enrolled in the prospective Mayo Clinic Study of Aging were evaluated at baseline and every 15 months to identify incident MCI or dementia.

Results: Over a median follow-up of 5.1 years, 153 of 534 participants (28.7%) with prevalent or incident MCI progressed to dementia (71.3 per 1,000 person-years). The cumulative incidence of dementia was 5.4% at 1 year, 16.1% at 2, 23.4% at 3, 31.1% at 4, and 42.5% at 5 years. The risk of dementia was elevated in MCI cases (hazard ratio [HR] 23.2, p < 0.001) compared with CN subjects. Thirty-eight percent (n = 201) of MCI participants reverted to CN (175.0/1,000 person-years), but 65% subsequently developed MCI or dementia; the HR was 6.6 (p < 0.001) compared with CN subjects. The risk of reversion was reduced in subjects with an APOE ε4 allele (HR 0.53, p < 0.001), higher Clinical Dementia Rating Scale-Sum of Boxes (HR 0.56, p < 0.001), and poorer cognitive function (HR 0.56, p < 0.001). The risk was also reduced in subjects with amnestic MCI (HR 0.70, p = 0.02) and multidomain MCI (HR 0.61, p = 0.003).

Conclusions: MCI cases, including those who revert to CN, have a high risk of progressing to dementia. This suggests that diagnosis of MCI at any time has prognostic value.

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Figures

Figure 1
Figure 1. Study flowchart
MCI = mild cognitive impairment.
Figure 2
Figure 2. Cumulative incidence of dementia in subjects who developed MCI and did not revert to CN, subjects who developed MCI and reverted to CN, and subjects who were CN at baseline
For graphic representation and to avoid confounding by age and sex, we identified 172 subjects who developed mild cognitive impairment (MCI) but experienced a reversion and matched them by age and sex to 172 subjects who developed MCI and did not revert, and to 172 subjects who were cognitively normal (CN) at baseline. When multiple subjects were available for matching, we chose one randomly.
See this image and copyright information in PMC

Comment in

References

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