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Mild cognitive impairment in the general population: occurrence and progression to Alzheimer disease.

Abstract

OBJECTIVES

Our aims were to 1) detect the occurrence of three mild cognitive impairment (MCI) subtypes in the general population; 2) identify cases of cognitive impairment which are not detected by current operational criteria for MCI and; 3) determine the predictive value of the subtypes for identifying future Alzheimer disease (AD).

DESIGN

Three-year prospective study.

SETTING

Population-based Swedish study, the Kungsholmen Project.

PARTICIPANTS

Three hundred seventy-nine nondemented older adults aged 75-95.

MEASUREMENTS

Standard plus modified MCI criteria were applied at baseline. In the modified definitions, the requirement for normal general cognition was removed. A category for persons without MCI who had only global cognitive deficits was added. Three-year progression to AD was assessed (DSM-III-R criteria).

RESULTS

Occurrence per 100 nondemented persons of MCI-amnestic, MCI-multidomains, and MCI-single-nonmemory was 2.1%, 1.8%, and 7.2%, respectively. When applying modified definitions for MCI-amnestic and MCI-multidomains, the occurrence almost doubled. Seven percent of the sample had impairment on a global cognitive task but performed at normal levels on all other domain-specific tasks. MCI-multidomains showed the highest progression to AD (hazard ratio [HR]: 23.6, 9.3-60.1). MCI-amnestic reached similar predictivity only when using the modified definition (HR: 17.9, 6.8-46.9). Even participants without MCI who had only global deficits had a ninefold risk of AD (HR: 9.1, 2.8-29.4).

CONCLUSIONS

Two-thirds of MCI-multidomains, but only half of MCI-amnestic progress to AD. The standard MCI criteria failed to identify those people with global cognitive deficits who have, however, a high risk of progressing to AD.

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  • Authors+Show Affiliations

    ,

    Aging Research Center, Karolinska Institutet, and Stockholm Gerontology Research Center, Stockholm, Sweden. katie.palmer@ki.se

    , ,

    Source

    MeSH

    Aged
    Aged, 80 and over
    Cognition Disorders
    Dementia
    Diagnostic and Statistical Manual of Mental Disorders
    Disease Progression
    Female
    Humans
    Male
    Memory Disorders
    Predictive Value of Tests
    Prevalence
    Proportional Hazards Models
    Prospective Studies
    Risk
    Sweden

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    18591580

    Citation

    Palmer, Katie, et al. "Mild Cognitive Impairment in the General Population: Occurrence and Progression to Alzheimer Disease." The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, vol. 16, no. 7, 2008, pp. 603-11.
    Palmer K, Bäckman L, Winblad B, et al. Mild cognitive impairment in the general population: occurrence and progression to Alzheimer disease. Am J Geriatr Psychiatry. 2008;16(7):603-11.
    Palmer, K., Bäckman, L., Winblad, B., & Fratiglioni, L. (2008). Mild cognitive impairment in the general population: occurrence and progression to Alzheimer disease. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 16(7), pp. 603-11. doi:10.1097/JGP.0b013e3181753a64.
    Palmer K, et al. Mild Cognitive Impairment in the General Population: Occurrence and Progression to Alzheimer Disease. Am J Geriatr Psychiatry. 2008;16(7):603-11. PubMed PMID: 18591580.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Mild cognitive impairment in the general population: occurrence and progression to Alzheimer disease. AU - Palmer,Katie, AU - Bäckman,Lars, AU - Winblad,Bengt, AU - Fratiglioni,Laura, PY - 2008/7/2/pubmed PY - 2008/8/30/medline PY - 2008/7/2/entrez SP - 603 EP - 11 JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry JO - Am J Geriatr Psychiatry VL - 16 IS - 7 N2 - OBJECTIVES: Our aims were to 1) detect the occurrence of three mild cognitive impairment (MCI) subtypes in the general population; 2) identify cases of cognitive impairment which are not detected by current operational criteria for MCI and; 3) determine the predictive value of the subtypes for identifying future Alzheimer disease (AD). DESIGN: Three-year prospective study. SETTING: Population-based Swedish study, the Kungsholmen Project. PARTICIPANTS: Three hundred seventy-nine nondemented older adults aged 75-95. MEASUREMENTS: Standard plus modified MCI criteria were applied at baseline. In the modified definitions, the requirement for normal general cognition was removed. A category for persons without MCI who had only global cognitive deficits was added. Three-year progression to AD was assessed (DSM-III-R criteria). RESULTS: Occurrence per 100 nondemented persons of MCI-amnestic, MCI-multidomains, and MCI-single-nonmemory was 2.1%, 1.8%, and 7.2%, respectively. When applying modified definitions for MCI-amnestic and MCI-multidomains, the occurrence almost doubled. Seven percent of the sample had impairment on a global cognitive task but performed at normal levels on all other domain-specific tasks. MCI-multidomains showed the highest progression to AD (hazard ratio [HR]: 23.6, 9.3-60.1). MCI-amnestic reached similar predictivity only when using the modified definition (HR: 17.9, 6.8-46.9). Even participants without MCI who had only global deficits had a ninefold risk of AD (HR: 9.1, 2.8-29.4). CONCLUSIONS: Two-thirds of MCI-multidomains, but only half of MCI-amnestic progress to AD. The standard MCI criteria failed to identify those people with global cognitive deficits who have, however, a high risk of progressing to AD. SN - 1545-7214 UR - https://www.unboundmedicine.com/medline/citation/18591580/Mild_cognitive_impairment_in_the_general_population:_occurrence_and_progression_to_Alzheimer_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/16/7/603 DB - PRIME DP - Unbound Medicine ER -