From the Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain (M.J.A., J.M.J.V., L.B., L.Z., C.W.-M.W., A.B., N.S., R.M., J.J.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Julius Center for Health Sciences and Primary Care (M.J.A., J.M.J.V., M.I.G.), University Medical Center Utrecht; Amsterdam UMC (M.J.A.), Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, the Netherlands; and National Institute of Science and Technology in Molecular Medicine (L.B.), Federal University of Minas Gerais, Belo Horizonte, Brazil.
Neurology. 2022 Jan 4;98(1):e15-e26. doi: 10.1212/WNL.0000000000013017. Epub 2021 Dec 1.
To investigate sociodemographic and medical predictors of incident mild cognitive impairment (MCI) and subsequent course of MCI at follow-up, including sustained MCI diagnosis, classification as cognitively normal, and progression to dementia.
Within a community-based cohort, diagnoses of MCI were made with a published algorithm. Diagnosis of dementia was based on clinical consensus. Cox regressions estimated hazard ratios of incident MCI associated with several predictors. Modified Poisson regressions estimated relative risks associated with predictors of diagnostic status at follow-up after incidence.
Among 2,903 cognitively normal participants at baseline, 752 developed MCI over an average of 6.3 (SD 4.5) years (incidence rate 56 per 1,000 person-years). Presence of ε4 and higher medical burden increased risk of incident MCI, while more years of education, more leisure activities, and higher income decreased this risk. Of the incident MCI cases, after an average of 2.4 years of follow-up, 12.9% progressed to dementia, 9.6% declined in functioning and did not meet the algorithmic criteria for MCI but did not meet the clinical criteria for dementia, 29.6% continued to meet MCI criteria, and 47.9% no longer met MCI criteria. Multidomain MCI, presence of ε4 depressive symptoms, and antidepressant use increased the risk of progression to dementia.
This community-based study showed that almost half of the individuals with incident MCI diagnoses were classified as cognitively normal at follow-up. Predictors of incident MCI demonstrably differed from those of subsequent MCI course; these findings can refine expectations for cognitive and functional course of those presenting with MCI.
调查社会人口统计学和医学预测因素与轻度认知障碍（MCI）的发生以及随访时 MCI 的后续病程，包括持续的 MCI 诊断、认知正常的分类以及进展为痴呆。
在社区为基础的队列中，使用已发表的算法对 MCI 进行诊断。痴呆的诊断基于临床共识。Cox 回归估计与多个预测因素相关的 MCI 发病风险的风险比。校正 Poisson 回归估计与 MCI 发病后随访时诊断状态相关的预测因素的相对风险。
在基线时认知正常的 2903 名参与者中，平均 6.3（SD 4.5）年后有 752 人发生 MCI（发生率为 56 例/1000 人年）。存在 ε4 和更高的医疗负担增加了发生 MCI 的风险，而更高的受教育程度、更多的休闲活动和更高的收入降低了这种风险。在发生 MCI 的病例中，平均随访 2.4 年后，12.9%进展为痴呆，9.6%的认知功能下降但不符合 MCI 算法标准但不符合痴呆的临床标准，29.6%的患者继续符合 MCI 标准，47.9%的患者不再符合 MCI 标准。多领域 MCI、存在 ε4、抑郁症状和使用抗抑郁药增加了进展为痴呆的风险。
这项以社区为基础的研究表明，近一半的新发 MCI 诊断患者在随访时被归类为认知正常。MCI 发病的预测因素与随后的 MCI 病程明显不同；这些发现可以更准确地预测那些出现 MCI 的患者的认知和功能进程。
