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Functional and cognitive criteria produce different rates of mild cognitive impairment and conversion to dementia
  1. J Saxton1,
  2. B E Snitz1,
  3. O L Lopez1,
  4. D G Ives1,
  5. L O Dunn1,
  6. A Fitzpatrick2,
  7. M C Carlson3,
  8. S T DeKosky4,
  9. for the GEM Study Investigators
  1. 1
    University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2
    University of Washington, Seattle, Washington, USA
  3. 3
    Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  4. 4
    University of Virginia, Charlottesville, Virginia, USA
  1. Dr J Saxton, Department of Neurology, University of Pittsburgh, 3471 Fifth Avenue, Suite 811, Pittsburgh, PA 15213, USA; saxtonja{at}upmc.edu

Abstract

Objective: To compare rates of mild cognitive impairment (MCI) and rates of progression to dementia using different MCI diagnostic systems.

Methods: MCI was investigated at baseline in 3063 community dwelling non-demented elderly in the Ginkgo Evaluation of Memory (GEM) study who were evaluated every 6 months to identify the presence of dementia. Overall MCI frequency was determined using (1) a Clinical Dementia Rating (CDR) score of 0.5 and (2) neuropsychological (NP) criteria, defined by impairment on standard cognitive tests.

Results: 40.2% of participants met CDR MCI criteria and 28.2% met NP MCI criteria (amnestic MCI = 16.6%). 15.7% were classified as MCI by both criteria and 47.4% as normal by both. Discordant diagnoses were observed in 24.5% who met NP normal/CDR MCI and in 12.4% who met NP MCI/CDR normal. Factors associated with CDR MCI among NP normal included lower education, lower NP scores, more instrumental activities of daily living impairment, greater symptoms of depression and subjective health problems. Individuals meeting NP MCI/CDR normal were significantly more likely to develop dementia over the median follow-up of 6.1 years than those meeting NP normal/CDR MCI.

Conclusions: Different criteria produce different MCI rates and different conversion rates to dementia. Although a higher percentage of MCI was identified by CDR than NP, a higher percentage of NP MCI progressed to dementia. These findings suggest that the CDR is sensitive to subtle changes in cognition not identified by the NP algorithm but is also sensitive to demographic and clinical factors probably leading to a greater number of false positives. These results suggest that identifying all individuals with CDR scores of 0.5 as Alzheimer’s disease is not advisable.

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Footnotes

  • Competing interests: None.

  • Funding: This study was supported by grant U01 AT000162 from the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Dietary Supplements and National Institute on Aging; National Heart, Lung, and Blood Institute; University of Pittsburgh Alzheimer’s Disease Research Center (P50AG05133); Roena Kulynych Center for Memory and Cognition Research; Wake Forest University School of Medicine; and National Institute of Neurological Disorders and Stroke. Schwabe Pharmaceuticals, Karlsruhe, Germany, donated the G biloba tablets and identical placebos in blister packs for the study.

  • Ethics approval: The study was approved by the institutional review boards of each of the participating sites.

  • ▸ Details of the Ginkgo Evaluation of Memory (GEM) Study Investigators are published online only at http://jnnp.bmj.com/content/vol80/issue7

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