Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA.
Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Alzheimers Dis. 2022;85(2):627-644. doi: 10.3233/JAD-210455.
Actuarial and statistical methods have been proposed as alternatives to conventional methods of diagnosing mild cognitive impairment (MCI), with the aim of enhancing diagnostic and prognostic validity, but have not been compared in racially diverse samples.
We compared the agreement of consensus, actuarial, and statistical MCI diagnostic methods, and their relationship to race and prognostic indicators, among diverse older adults.
Participants (N = 354; M age = 71; 68% White, 29% Black) were diagnosed with MCI or normal cognition (NC) according to clinical consensus, actuarial neuropsychological criteria (Jak/Bondi), and latent class analysis (LCA). We examined associations with race/ethnicity, longitudinal cognitive and functional change, and incident dementia.
MCI rates by consensus, actuarial criteria, and LCA were 44%, 53%, and 41%, respectively. LCA identified three MCI subtypes (memory; memory/language; memory/executive) and two NC classes (low normal; high normal). Diagnostic agreement was substantial, but agreement of the actuarial method with consensus and LCA was weaker than the agreement between consensus and LCA. Among cases classified as MCI by actuarial criteria only, Black participants were over-represented, and outcomes were generally similar to those of NC participants. Consensus diagnoses best predicted longitudinal outcomes overall, whereas actuarial diagnoses best predicted longitudinal functional change among Black participants.
Consensus diagnoses optimize specificity in predicting dementia, but among Black older adults, actuarial diagnoses may be more sensitive to early signs of decline. Results highlight the need for cross-cultural validity in MCI diagnosis and should be explored in community- and population-based samples.
为了提高诊断和预后的准确性，已经提出了精算和统计方法作为诊断轻度认知障碍（MCI）的传统方法的替代方法，但尚未在不同种族的样本中进行比较。
我们比较了共识、精算和统计 MCI 诊断方法的一致性，以及它们与种族和预后指标的关系，这些方法在不同的老年人群中使用。
根据临床共识、精算神经心理学标准（Jak/Bondi）和潜在类别分析（LCA），将 354 名参与者（M 年龄=71；68%为白人，29%为黑人）诊断为 MCI 或正常认知（NC）。我们研究了与种族/民族、纵向认知和功能变化以及发生痴呆的相关性。
共识、精算标准和 LCA 确定的 MCI 发生率分别为 44%、53%和 41%。LCA 确定了三种 MCI 亚型（记忆；记忆/语言；记忆/执行）和两种 NC 类别（低正常；高正常）。诊断一致性较高，但精算方法与共识和 LCA 的一致性不如共识与 LCA 的一致性。在仅根据精算标准分类为 MCI 的病例中，黑人参与者的比例过高，结果与 NC 参与者的结果大致相同。共识诊断总体上最能预测纵向结局，而精算诊断最能预测黑人参与者的纵向功能变化。
共识诊断最有利于预测痴呆，但在老年黑人中，精算诊断可能对早期衰退迹象更敏感。结果强调了 MCI 诊断中跨文化有效性的必要性，应在社区和人群为基础的样本中进行探讨。
