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Review
. 2025 Mar 12;17(1):e70074.
doi: 10.1002/dad2.70074. eCollection 2025 Jan-Mar.

The prognosis of mild cognitive impairment: A systematic review and meta-analysis

Simone Salemme  1   2 , Flavia Lucia Lombardo  3 , Eleonora Lacorte  3 , Francesco Sciancalepore  3 , Giulia Remoli  4 , Ilaria Bacigalupo  3 , Paola Piscopo  5 , Giovanna Zamboni  1   6 , Paolo Maria Rossini  7   8 , Stefano Francesco Cappa  9   10 , Daniela Perani  11 , Patrizia Spadin  12 , Fabrizio Tagliavini  13 , Nicola Vanacore  3 , Antonio Ancidoni  3
Affiliations
Review

The prognosis of mild cognitive impairment: A systematic review and meta-analysis

Simone Salemme et al. Alzheimers Dement (Amst). .

Erratum in

Abstract

Introduction: Knowledge gaps remain about the prognosis of mild cognitive impairment (MCI). Conversion rates to dementia vary widely, and reversion to normal cognition has gained attention. This review updates evidence on MCI conversion risk and probability of stability and reversion.

Methods: We searched databases for studies on MCI prognosis with ≥3 years of follow-up, established criteria for MCI and dementia, and performed a meta-analysis using a random-effects model to assess conversion risk, reversion, and stability probability. Meta-regressions identified sources of heterogeneity and guided subgroup analysis.

Results: From 89 studies (mean follow-up: 5.2 years), conversion risk was 41.5% (38.3%-44.7%) in clinical and 27.0% (22.0%-32.0%) in population-based studies, with Alzheimer's dementia as the most common outcome. Stability rates were 49.3% (clinical) and 49.8% (population). Reversion was 8.7% (clinical) and 28.2% (population).

Discussion: Our findings highlight higher conversion in clinical settings and 30% reversion in population studies, calling for sustainable care pathway development.

Highlights: Prognosis for mild cognitive impairment (MCI) varies by setting; dementia risk is higher and the probability of reversion is lower in clinical-based studies.In both clinical and population settings, cognitive stability is ≈50%.A reorganization of health services could ensure sustainable care for individuals with MCI.Significant heterogeneity in MCI studies impacts data interpretation; follow-up length is crucial.Long-term prognosis studies on MCI in low- and middle-income countries are urgently needed.

Keywords: Alzheimer's disease; MCI; brain health; cognitive decline; conversion; decentralization; dementia; functional ability; meta‐analysis; primary health care; quality of care; reversion; sustainability.

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Conflict of interest statement

F.T. received honoraria from Biogen for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events. The other authors have no conflicting interests relevant to the manuscript. Author disclosures are available in the Supporting Information.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) flow diagram. Note: Studies evaluating conversion, stability, and reversion are not mutually exclusive.
FIGURE 2
FIGURE 2
World map of included studies by WHO region. AMR, Region of the Americas; C, number of studies included in the meta‐analysis of the probability of conversion; EUR, European Region; MCI, mild cognitive impairment; R, number of studies included in meta‐analysis of the probability of reversion to normal cognition; S, number of studies included in the meta‐analysis of the probability of cognitive stability; SEAR, South‐East Asia Region; WHO, World Health Organization; WPR, Western Pacific Region. MCI is expressed as the absolute number of individuals with a diagnosis of mild cognitive impairment at baseline. Note: Studies evaluating conversion, stability, and reversion are not mutually exclusive. Three studies were conducted in geographically mixed cohorts and are not reported in the regional tables.
FIGURE 3
FIGURE 3
Forest plot of the probability of conversion to dementia. ES, effect size; weight, inverse‐variance weights obtained from a random‐effects model.
FIGURE 4
FIGURE 4
Forest plot of the probability of cognitive stability. ES, effect size; weight, inverse‐variance weights obtained from a random‐effects model.
FIGURE 5
FIGURE 5
Forest plot of the probability of reversion to normal cognition. ES, effect size; weight, inverse‐variance weights obtained from a random‐effects model.
See this image and copyright information in PMC

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