Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales Medicine, Sydney, New South Wales, Australia.
PLoS One. 2013;8(3):e59649. doi: 10.1371/journal.pone.0059649. Epub 2013 Mar 27.
Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. However, many individuals diagnosed with MCI are found to have reverted to normal cognition on follow-up. This study investigated factors predicting or associated with reversion from MCI to normal cognition.
Our analyses considered 223 participants (48.9% male) aged 71-89 years, drawn from the prospective, population-based Sydney Memory and Ageing Study. All were diagnosed with MCI at baseline and subsequently classified with either normal cognition or repeat diagnosis of MCI after two years (a further 11 participants who progressed from MCI to dementia were excluded). Associations with reversion were investigated for (1) baseline factors that included diagnostic features, personality, neuroimaging, sociodemographics, lifestyle, and physical and mental health; (2) longitudinal change in potentially modifiable factors.
There were 66 reverters to normal cognition and 157 non-reverters (stable MCI). Regression analyses identified diagnostic features as most predictive of prognosis, with reversion less likely in participants with multiple-domain MCI (p = 0.011), a moderately or severely impaired cognitive domain (p = 0.002 and p = 0.006), or an informant-based memory complaint (p = 0.031). Reversion was also less likely for participants with arthritis (p = 0.037), but more likely for participants with higher complex mental activity (p = 0.003), greater openness to experience (p = 0.041), better vision (p = 0.014), better smelling ability (p = 0.040), or larger combined volume of the left hippocampus and left amygdala (p<0.040). Reversion was also associated with a larger drop in diastolic blood pressure between baseline and follow-up (p = 0.026).
Numerous factors are associated with reversion from MCI to normal cognition. Assessing these factors could facilitate more accurate prognosis of individuals with MCI. Participation in cognitively enriching activities and efforts to lower blood pressure might promote reversion.
轻度认知障碍 (MCI) 与痴呆症的发病风险增加有关。然而，许多被诊断为 MCI 的患者在随访中发现认知功能已恢复正常。本研究旨在探讨预测或与 MCI 恢复正常认知相关的因素。
我们的分析纳入了 223 名年龄在 71-89 岁的参与者（48.9%为男性），他们来自前瞻性、基于人群的悉尼记忆与衰老研究。所有参与者在基线时均被诊断为 MCI，随后根据两年后的认知状态分为正常认知或 MCI 复发（11 名从 MCI 进展为痴呆的参与者被排除在外）。我们研究了与恢复正常认知相关的因素：（1）基线时的因素，包括诊断特征、个性、神经影像学、社会人口统计学、生活方式、身体和心理健康；（2）潜在可改变因素的纵向变化。
有 66 名患者恢复正常认知，157 名患者认知状态未恢复（稳定 MCI）。回归分析表明，诊断特征是预测预后的最重要因素，具有多领域 MCI（p=0.011）、认知域中度或严重受损（p=0.002 和 p=0.006）或基于知情者的记忆主诉（p=0.031）的患者恢复正常认知的可能性较低。关节炎患者（p=0.037）恢复正常认知的可能性较低，但复杂精神活动较多（p=0.003）、开放性更高（p=0.041）、视力更好（p=0.014）、嗅觉能力更好（p=0.040）或左海马和左杏仁核联合体积较大（p<0.040）的患者恢复正常认知的可能性更高。血压舒张压在基线和随访之间的降幅较大（p=0.026）与恢复正常认知相关。
许多因素与 MCI 恢复正常认知相关。评估这些因素有助于更准确地预测 MCI 患者的预后。参与认知丰富的活动和努力降低血压可能促进恢复。
