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Can Clinical Data Predict Progression to Dementia in Amnestic Mild Cognitive Impairment?

Published online by Cambridge University Press:  02 December 2014

Lesley Fellows ,
Howard Bergman ,
Christina Wolfson  and
Howard Chertkow
Lesley Fellows
Affiliation:
Dept. of Neurology and Neurosurgery, Division of Clinical Epidemiology, McGill University Health Centre
Howard Bergman
Affiliation:
Bloomfield Centre for Research in Aging Division of Geriatric Medicine, Dept. of Medicine, McGill University Health Centre
Christina Wolfson
Affiliation:
Department of Epidemiology, Biostatistics & Occupational Health, Department of Medicine, McGill University
Howard Chertkow
Affiliation:
Bloomfield Centre for Research in Aging Division of Geriatric Medicine, Dept. of Medicine, McGill University Health Centre Dept. of Neurology and Neurosurgery, Division of Clinical Epidemiology, McGill University Health Centre Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
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Abstract

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Background:

To determine whether clinical data obtained by history and physical examination can predict eventual progression to dementia in a cohort of elderly people with mild cognitive impairment.

Methods:

A prospective, longitudinal study of a cohort of elderly subjects with amnestic Mild Cognitive Impairment (MCI). Ninety subjects meeting the criteria for amnestic MCI were recruited and followed annually for an average of 3.3 years. Main outcome measure was the development of dementia determined by clinical assessment with confirmatory neuropsychological evaluation.

Results:

Fifty patients (56%) developed dementia on follow-up. They were older, had lower Mini-mental status exam (MMSE) scores and a shorter duration of symptoms at the time of first assessment. Multivariate logistic regression analysis identified age at symptom onset as the only clinical parameter which distinguished the group that deteriorated to dementia from the group that did not. The odds ratio for age was 1.1 (confidence interval 1.04 - 1.18).

Conclusions:

Patients presenting with amnestic MCI insufficient for the diagnosis of dementia are at high risk of developing dementia on follow-up. In our cohort, 56% were diagnosed with dementia over an average period of 5.9 years from symptom onset. The only clinical predictor for the eventual development of dementia was older age at symptom onset. Clinical features alone were insufficient to predict development of dementia.

Résumé:

<span class='bold'>RÉSUMÉ:</span><span class='bold'><span class='italic'>Contexte:</span></span>

Le but de cette étude était de déterminer si les données cliniques provenant de l’histoire médicale et de l’examen physique peuvent prédire la progression éventuelle vers la démence dans une cohorte de gens àgés ayant une atteinte cognitive légère.

<span class='bold'><span class='italic'>Méthodes:</span></span>

Il s’agit d’une étude longitudinale prospective d’une cohorte de sujets àgés ayant une atteinte cognitive légère (ACL). Quatre-vingt- dix sujets rencontrant les critères diagnostiques de l’ACL amnésique ont été recrutés et suivis annuellement pendant 3,3 ans en moyenne. Le critère d’évaluation principal était l’apparition d’une démence selon l’évaluation clinique confirmée par une évaluation neuropsychologique.

<span class='bold'><span class='italic'>Résultats:</span></span>

Cinquante patients (56%) ont développé une démence au cours du suivi. Ils étaient plus àgés, avaient des scores MMSE plus bas et un début des symptömes plus récent au moment de la première évaluation. Une analyse de régression logistique multivariée a identifié l’àge au moment du début des symptömes comme le seul paramètre clinique qui distinguait le groupe de patients qui évoluaient vers une démence du groupe de patients sans démence. Le rapport de cotes pour l’àge était 1,1 (IC 1,04 à 1,18).

<span class='bold'><span class='italic'>Conclusions:</span></span>

Les patients qui consultent pour une ACL amnésique dont le tableau clinique n’est pas suffisamment sévère pour qu’on pose un diagnostic de démence sont à haut risque de présenter une démence par la suite. On a posé un diagnostic de démence chez 56% des patients de cette cohorte, en moyenne 5,9 ans après le début des symptömes. La seule donnée qui prédisait l’apparition éventuelle de la démence était un àge plus avancé au début des symptömes. Les caractéristiques cliniques étaient insuffisantes pour prédire le développement de la démence.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 3 , July 2008 , pp. 314 - 322
Copyright
Copyright © The Canadian Journal of Neurological 2008

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