Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, India.
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, India.
Dement Geriatr Cogn Disord. 2023;52(2):91-107. doi: 10.1159/000529255. Epub 2023 Apr 4.
The study aimed to explore longitudinal cognitive outcomes and to ascertain predictors of conversion to dementia in a hospital-based mild cognitive impairment (MCI) cohort classified according to the neuropsychological phenotype at baseline.
Subjects aged >55 years who had a clinical diagnosis of MCI at initial visit between 2010 and 2018, with at least one formal neuropsychological assessment at baseline and follow-up of a minimum of 2 years were included. The prospective study was completed based on evaluation at last follow-up to gauge conversion to dementia, quantification of performance on activities of daily living and when available, longitudinal neuropsychological test scores.
Ninety-five patients with MCI met the inclusion criteria with a mean age of 68.4 ± 6.4 years at baseline and a mean duration of follow-up for 6.4 ± 3.2 years. The cumulative conversion rate to dementia was 22.2% (21/95) and the annualized conversion rate was 3.3% per year of follow-up. The majority of subjects who had converted had multidomain MCI (66%). Only white matter changes on MRI brain revealed correlation with baseline neuropsychology tests. The multivariate logistic regression analysis revealed the utility of lower baseline list recognition (adjusted odds ratio: 0.735 [95% confidence interval: 0.589-0.916]; p 0.006), lower immediate logical memory (0.885 [0.790-0.990]; p 0.03), and high perseverative error scores on set shifting (3.116 [1.425-6.817]; p 0.004) as predictors of conversion. A model score of +2.615 could predict conversion with sensitivity of 72% and specificity of 98% over 6.4 years follow-up.
There was a higher risk of conversion associated with multidomain MCI. Logistic regression-based estimations of dementia risk utilizing domain-based neuropsychology test scores in MCI have high specificity for diagnosis at baseline.
本研究旨在探索纵向认知结果，并确定根据基线时的神经心理学表型分类的基于医院的轻度认知障碍（MCI）队列中向痴呆转化的预测因素。
纳入 2010 年至 2018 年间初次就诊时临床诊断为 MCI、基线和随访至少 2 年至少有一次正式神经心理学评估的年龄>55 岁的受试者。根据最后一次随访时的评估完成前瞻性研究，以评估向痴呆的转化、日常生活活动能力的评估以及在可能的情况下纵向神经心理学测试评分。
95 名 MCI 患者符合纳入标准，基线时平均年龄为 68.4±6.4 岁，平均随访时间为 6.4±3.2 年。向痴呆的累积转化率为 22.2%（21/95），每年的转化率为 3.3%。大多数转化的患者为多域 MCI（66%）。只有 MRI 脑的白质变化与基线神经心理学测试相关。多变量逻辑回归分析显示基线认知测试的低列表识别（调整后的优势比：0.735[95%置信区间：0.589-0.916]；p 0.006）、低即时逻辑记忆（0.885[0.790-0.990]；p 0.03）和高持续错误分数的转变（3.116[1.425-6.817]；p 0.004）是转化的预测因素。模型分数为+2.615 可以在 6.4 年的随访中预测转化率，其敏感性为 72%，特异性为 98%。
多域 MCI 与更高的转化风险相关。基于逻辑回归的基于 MCI 中基于域的神经心理学测试评分的痴呆风险估计在基线时具有高特异性的诊断。
