Department of Epidemiology and Health Services, University of Washington, Seattle, USA.
Neurology. 2012 Oct 9;79(15):1591-8. doi: 10.1212/WNL.0b013e31826e26b7. Epub 2012 Sep 26.
We sought to identify characteristics of individuals with mild cognitive impairment (MCI) that are associated with a relatively high probability of reverting back to normal cognition, and to estimate the risk of future cognitive decline among those who revert.
We first studied 3,020 individuals diagnosed with MCI on at least 1 visit to an Alzheimer's Disease Center in the United States. All underwent standardized Uniform Data Set evaluations at their first visit with an MCI diagnosis and on a subsequent visit, about 1 year later, at which cognitive status was reassessed. Multiple logistic regression was used to identify predictors of reverting from MCI back to normal cognition. We then estimated the risk of developing MCI or dementia over the next 3 years among those who had reverted, compared with individuals who had not had a study visit with MCI.
About 16% of subjects diagnosed with MCI reverted back to normal or near-normal cognition approximately 1 year later. Five characteristics assessed at the first MCI visit contributed significantly to a model predicting a return to normal cognition: Mini-Mental State Examination (MMSE) score, Clinical Dementia Rating (CDR) score, MCI type, Functional Activities Questionnaire (FAQ) score, and APOE ε4 status. Survival analysis showed that the risk of retransitioning to MCI or dementia over the next 3 years was sharply elevated among those who had MCI and then improved, compared with individuals with no history of MCI.
Even in a cohort of patients seen at dementia research centers, reversion from MCI was fairly common. Nonetheless, those who reverted remained at increased risk for future cognitive decline.
我们旨在确定轻度认知障碍（MCI）患者的特征，这些特征与认知功能恢复正常的概率较高相关，并估计恢复正常认知的患者未来认知能力下降的风险。
我们首先研究了在美国阿尔茨海默病中心至少就诊一次被诊断为 MCI 的 3020 名个体。所有患者在首次 MCI 就诊时和大约 1 年后的后续就诊时均接受了标准化统一数据集评估，在此期间重新评估认知状态。采用多因素逻辑回归来确定从 MCI 恢复正常认知的预测因子。然后，我们估计了与未进行 MCI 研究就诊的个体相比，那些已经恢复的患者在接下来的 3 年内发展为 MCI 或痴呆的风险。
大约 16%的被诊断为 MCI 的患者在大约 1 年后恢复到正常或接近正常的认知状态。在首次 MCI 就诊时评估的 5 个特征显著预测了认知功能恢复正常：简易精神状态检查（MMSE）评分、临床痴呆评定量表（CDR）评分、MCI 类型、功能活动问卷（FAQ）评分和 APOE ε4 状态。生存分析显示，与没有 MCI 病史的个体相比，那些 MCI 恢复后又转至 MCI 或痴呆的患者在接下来的 3 年内重新发生 MCI 或痴呆的风险急剧升高。
即使在痴呆症研究中心就诊的患者队列中，从 MCI 恢复也较为常见。然而，那些恢复的患者仍存在未来认知能力下降的风险增加。
