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

Rosebud O Roberts, David S Knopman, Michelle M Mielke, Ruth H. Cha, V. Shane Pankratz, Teresa J H Christianson, Yonas Endale Geda, Bradley F Boeve, Robert J. Ivnik, Eric George Tangalos, Walter A Rocca, Ronald Carl Petersen

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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 5 534, 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 5 201) 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 e4 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 5 0.02) and multidomain MCI (HR 0.61, p 5 0.003). Conclusions: MCI cases, including thosewho revert to CN, have a high risk of progressing to dementia. This suggests that diagnosis of MCI at any time has prognostic value.

Original languageEnglish (US)
Pages (from-to)317-325
Number of pages9
JournalNeurology
Volume82
Issue number4
DOIs
StatePublished - Jan 28 2014

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ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

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