Predictive Factors for Conversion to Dementia in Individuals with Early-Onset Mild Cognitive Impairment

Introduction: There is little research on factors predicting conversion to dementia in early-onset mild cognitive impairment (eoMCI), a transitional stage between healthy ageing and dementia in individuals below the age of 65. We aimed to examine whether sociodemographic and clinical factors at initial presentation predicted dementia progression in a cohort of eoMCI patients attending a memory service, at a university teaching hospital in the UK. Methods: This is a retrospective case note study of individuals diagnosed with eoMCI between 2000 and 2013 at the Younger Person’s Memory Service (YPMS) in Leicestershire, England. Data collected at assessment included social factors, demographic characteristics, and medical and psychiatric history, as well as standardized cognitive assessment scores. Variables were analysed using χ2 or independent sample t tests to identify associations. A Cox regression survival analysis was done to identify predictive factors for dementia conversion. An ROC analysis for total CAMCOG was used to investigate sensitivity and specificity for dementia converters versus non-converters. Results: Out of 531 subjects who attended YPMS, 65 patients were given a diagnosis of eoMCI (47.7% female; mean age 56.4 ± 7.54 years). Of these, 21 (32.3%) converted to dementia during their course within the service. Comparison between subgroups revealed a significant association between dementia conversion and higher years of education and lower MMSE and CAMCOG (total and subscale) scores at baseline. Smoking history, alcohol use, or medical history such as diabetes or heart disease were not associated with conversion. Cox regression survival analysis showed higher education in years and lower total CAMCOG scores were significant predictors for conversion. Lower scores on the recent memory, remote memory, learning memory, and executive function subscales of the CAMCOG were also significant predictors for conversion. ROC curve analysis for total CAMCOG demonstrated that the best detection of dementia converters can be achieved with a cutoff score of 90.5/107 (sensitivity of 76.2% and specificity of 68.2%). Area under the curve was 0.808 (95% CI: 0.697–0.920). Conclusion: More years in education and lower cognitive scores on CAMCOG at initial assessment are associated with progression to dementia from eoMCI. Further research is required to explore these predictive factors more.

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Abstract 16664: Aortic Valve Calcification is Prognostic for Mild Cognitive Impairment

Circulation ◽

10.1161/circ.142.suppl_3.16664 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Hojune E Chung ◽

Jessica Chen ◽

Jared L Christensen ◽

Dhairyasheel S Ghosalkar ◽

Cullen Soares ◽

...

Keyword(s):

Lung Cancer ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Aortic Valve ◽

Cox Regression ◽

Smoking History ◽

Secondary Outcome ◽

Aortic Valve Calcification ◽

Valve Calcification ◽

Multivariate Adjustment

Introduction: While an association between vascular disease and dementia has been identified, few studies have assessed the longitudinal relationship between aortic valve calcification (AVC) and mild cognitive impairment (MCI). We recently found AVC to be associated with increased atherosclerotic events, and we sought to determine the prognostic value of AVC derived from low dose, lung cancer screening computed tomography (LCSCT) for MCI in a moderate-to-high atherosclerotic risk cohort. Methods: This was a single site, retrospective analysis of 1401 U.S. veterans (65 years [IQI: 61, 68] years; 97% male), who underwent quantification of AVC from LCSCT indicated for smoking history. Exclusion criteria included lung cancer, prior aortic valve replacement and prior MCI diagnosis. The primary outcome was new diagnosis of MCI identified by objective testing (Mini-Mental Status Exam or Montreal Cognitive Assessment) or by ICD coding. Secondary outcome was nonfatal cerebrovascular accident (CVA). Time-to-event analysis was carried out using AVC as a continuous and a categorical variable, and multivariate adjustment included age, diabetes mellitus, glomerular filtration rate <60 mL/min, coronary artery disease, and prior CVA. Results: Over a 5-year follow up, 110 patients (8%) were newly diagnosed with MCI and 45 patients (3%) had CVA. By Cox regression, AVC was predictive of MCI (HR: 1.15 [1.07 -1.24], p<0.001) and the association remained significant after multivariate adjustment (HR: 1.09 [1.01-1.18], p=0.026). Non-zero AVC tertiles were: 0.1-115; 116-427; and ≥428 Agatston Units. AVC was associated with MCI at increasing tertiles, and after multivariate analysis, the association remained significant (HR: 1.89 [1.09-3.28], p=0.024 and HR: 1.80 [1.01-3.20], p=0.047; tertiles 2 and 3, respectively). AVC was also associated with CVA (HR: 1.17 [1.05-1.32], p=0.006); however, the association lost significance after multivariate adjustment (HR: 1.12 [0.99-1.26], p=0.080). Conclusions: To our knowledge, this is the first study demonstrating that quantification of AVC from LCSCT is predictive of MCI. The association may be in part due to atherosclerotic thromboembolic events as there was a trend toward increasing nonfatal CVA in this population.

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Predictive factors for conversion to dementia in individuals with early‐onset mild cognitive impairment

Alzheimer s & Dementia ◽

10.1002/alz.054376 ◽

2021 ◽

Vol 17 (S6) ◽

Author(s):

Kate Baird ◽

Sarah Baillon ◽

Lilian Lau ◽

Mathew Storey ◽

James Lindesay ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Predictive Factors ◽

Early Onset

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Psychometric Properties of the Persian Montreal Cognitive Assessment in Mild Cognitive Impairment and Alzheimer Disease

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000514673 ◽

2021 ◽

pp. 51-57

Author(s):

Vahid Rashedi ◽

Mahshid Foroughan ◽

Negin Chehrehnegar

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Alzheimer Disease ◽

Psychometric Properties ◽

Cognitive Assessment ◽

Screening Test ◽

Cognitive Status ◽

Montreal Cognitive Assessment ◽

Cutoff Score ◽

Persian Version

Introduction: The Montreal Cognitive Assessment (MoCA) is a cognitive screening test widely used in clinical practice and suited for the detection of Mild Cognitive Impairment (MCI). The aims were to evaluate the psychometric properties of the Persian MoCA as a screening test for mild cognitive dysfunction in Iranian older adults and to assess its accuracy as a screening test for MCI and mild Alzheimer disease (AD). Method: One hundred twenty elderly with a mean age of 73.52 ± 7.46 years participated in this study. Twenty-one subjects had mild AD (MMSE score ≤21), 40 had MCI, and 59 were cognitively healthy controls. All the participants were administered the Mini-Mental State Examination (MMSE) to evaluate their general cognitive status. Also, a battery of comprehensive neuropsychological assessments was administered. Results: The mean score on the Persian version of the MoCA and the MMSE were 19.32 and 25.62 for MCI and 13.71 and 22.14 for AD patients, respectively. Using an optimal cutoff score of 22 the MoCA test detected 86% of MCI subjects, whereas the MMSE with a cutoff score of 26 detected 72% of MCI subjects. In AD patients with a cutoff score of 20, the MoCA had a sensitivity of 94% whereas the MMSE detected 61%. The specificity of the MoCA was 70% and 90% for MCI and AD, respectively. Discussion: The results of this study show that the Persian version of the MoCA is a reliable screening tool for detection of MCI and early stage AD. The MoCA is more sensitive than the MMSE in screening for cognitive impairment, proving it to be superior to MMSE in detecting MCI and mild AD.

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Prognosis of conversion of mild cognitive impairment to Alzheimer's dementia by voxel-wise Cox regression based on FDG PET data

NeuroImage Clinical ◽

10.1016/j.nicl.2018.101637 ◽

2019 ◽

Vol 21 ◽

pp. 101637 ◽

Cited By ~ 7

Author(s):

Arnd Sörensen ◽

Ganna Blazhenets ◽

Gerta Rücker ◽

Florian Schiller ◽

Philipp Tobias Meyer ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Fdg Pet ◽

Cox Regression ◽

Alzheimer’S Dementia ◽

Alzheimer's Dementia

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Modifiable Factors Associated with Reversion from Mild Cognitive Impairment to Cognitively Normal Status: A Prospective Cohort Study

10.21203/rs.3.rs-970706/v1 ◽

2021 ◽

Author(s):

Feng Sha ◽

Ziyi Zhao ◽

Chang Wei ◽

Zhirong Yang ◽

Bingyu Li

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Psychological Factors ◽

Large Scale ◽

Cox Regression ◽

Lifestyle Factors ◽

Cognitively Normal ◽

Factors Associated ◽

Modifiable Factors

Abstract Background Previous studies found that about 24% of the mild cognitive impairment (MCI) patients reverse to cognitively normal (CN) status. However, it is unclear which modifiable factors are associated with this reversion. Method We conducted a prospective community-based cohort study based on 2002-2018 Chinese Longitudinal Health Longevity Survey (CLHLS). Of 35,474 older adults from 22 provinces in China in the 5 waves of CLHLS, 7,422 eligible participants with MCI were included. Multivariable Cox regression with least absolute shrinkage and selection operator (LASSO) penalty for variable selection was adopted to investigate the associations between reversion to CN and potential modifiable dietary/lifestyle, cardiometabolic, and psychological factors. Results Our analysis included 7,422 MCI participants [average age: 90.0 (SD 9.5) years]. Among these participants, 1,604 (21.6%) reversed from MCI to CN with a mean (SD) follow-up of 2.9 (1.8) years. Several dietary/lifestyle factors, including daily consumption of fresh fruits (Hazard Ratio [HR]: 1.28, 95% CI: 1.15 to 1.42; P༜.001), engagement in reading (HR: 1.24, 95% CI: 1.00 to 1.54; P =.047), housework (HR: 1.21, 95% CI: 1.08 to 1.35; P =.001), and mah-jong or other card games (HR: 1.23, 95% CI: 1.08 to 1.39; P =.001), were positively associated with possibility of reversion. Cigarette smoking (HR: 0.92, 95% CI: 0.84 to 1.00; P= .041) and duration of alcohol drinking (HR: 0.97, 95% CI: 0.94 to 0.99; P = .012) were negatively associated with possibility of reversion. None of the modifiable cardiometabolic and psychological factors was found to be significantly associated with reversion to CN. Difference was identified among different age and gender group. Conclusion This study identified several dietary/lifestyle factors associated with MCI reversion that may transfer into large-scale dementia prevention practices.

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How can automated linguistic analysis help to discern functional cognitive disorder from healthy controls and mild cognitive impairment?

BJPsych Open ◽

10.1192/bjo.2021.78 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S7-S7

Author(s):

Lizzie Beavis ◽

Ronan O'Malley ◽

Bahman Mirheidari ◽

Heidi Christensen ◽

Daniel Blackburn

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Delayed Diagnosis ◽

Age Of Acquisition ◽

Linguistic Analysis ◽

Cross Sectional Study ◽

Cognitive Disorder ◽

Remote Memory ◽

Healthy Controls ◽

Cross Sectional

AimsThe disease burden of cognitive impairment is significant and increasing. The aetiology of cognitive impairment can be structural, such as in mild cognitive impairment (MCI) due to early Alzheimer's disease (AD), or in functional cognitive disorder (FCD), where there is no structural pathology. Many people with FCD receive a delayed diagnosis following invasive or costly investigations. Accurate, timely diagnosis improves outcomes across all patients with cognitive impairment. Research suggests that analysis of linguistic features of speech may provide a non-invasive diagnostic tool. This study aimed to investigate the linguistic differences in conversations between people with early signs of cognitive impairment with and without structural pathology, with a view to developing a screening tool using linguistic analysis of conversations.MethodIn this explorative, cross-sectional study, we recruited 25 people with MCI considered likely due to AD, (diagnosed according to Petersen's criteria and referred to as PwMCI), 25 healthy controls (HCs) and 15 people with FCD (PwFCD). Participants’ responses to a standard questionnaire asked by an interactional virtual agent (Digital Doctor) were quantified using previously identified parameters. This paper presents statistical analyses of the responses and a discussion of the results.ResultPwMCI produced fewer words than PwFCD and HCs. The ratio of pauses to speech was generally lower for PwMCI and PwFCD than for HCs. PwMCI showed a greater pause to speech ratio for recent questions (such as ‘what did you do at the weekend?’) compared with the HCs. Those with FCD showed the greatest pause to speech ratio in remote memory questions (such as ‘what was your first job?’). The average age of acquisition of answers for verbal fluency questions was lower in the MCI group than HCs.ConclusionThe results and qualitative observations support the relative preservation of remote memory compared to recent memory in MCI due to AD and decreased spontaneous elaboration in MCI compared with healthy controls and patients with FCD. Word count, age of acquisition and pause to speech ratio could form part of a diagnostic toolkit in identifying those with structural and functional causes of cognitive impairment. Further investigation is required using a large sample.

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Associations between cognitive impairment at onset and disability accrual in young people with multiple sclerosis

Scientific Reports ◽

10.1038/s41598-019-54153-7 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Antonio Carotenuto ◽

◽

Marcello Moccia ◽

Teresa Costabile ◽

Elisabetta Signoriello ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Young People ◽

Clinical Outcomes ◽

Cognitive Abilities ◽

Early Onset ◽

Visual Memory ◽

Cox Regression ◽

Disease Onset

AbstractDifferently from the adult multiple sclerosis (MS) population, the predictive value of cognitive impairment in early-onset MS is still unknown. We aim to evaluate whether cognitive performances at disease onset predict disease progression in young people with MS. This is a retrospective study on early onset (<25 years) MS patients, who had a baseline cognitive evaluation at disease onset. Demographic and longitudinal clinical data were collected up to 7 years follow up. Cognitive abilities were assessed at baseline through the Brief Repeatable Battery. Associations between cognitive abilities and clinical outcomes (occurrence of a relapse, and 1-point EDSS progression) were evaluated with stepwise logistic and Cox regression models. We included 51 patients (26 females), with a mean age at MS onset of 17.2 ± 3.9 years, and an EDSS of 2.5 (1.0–6.0). Over the follow-up, twenty-five patients had at least one relapse, and 7 patients had 1-point EDSS progression. Relapse occurrence was associated with lower 10/36 SPART scores (HR = 0.92; p = 0.002) and higher WLG scores (HR = 1.05; p = 0.01). EDSS progression was associated with lower SDMT score (OR: 0.70; p = 0.04). Worse visual memory and attention/information processing were associated with relapses and with increased motor disability after up to 7-years follow-up. Therefor, specific cognitive subdomains might better predict clinical outcomes than the overall cognitive impairment in early-onset MS.

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Prognosis of Early-Onset vs. Late-Onset Mild Cognitive Impairment: Comparison of Conversion Rates and Its Predictors

Geriatrics ◽

10.3390/geriatrics1020011 ◽

2016 ◽

Vol 1 (2) ◽

pp. 11 ◽

Cited By ~ 4

Author(s):

Miguel Tábuas-Pereira ◽

Inês Baldeiras ◽

Diana Duro ◽

Beatriz Santiago ◽

Maria Ribeiro ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Early Onset ◽

Late Onset ◽

Conversion Rates

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Sleep Disturbances and Predictive Factors in Caregivers of Patients with Mild Cognitive Impairment and Dementia

Journal of Clinical Neurology ◽

10.3988/jcn.2014.10.4.304 ◽

2014 ◽

Vol 10 (4) ◽

pp. 304 ◽

Cited By ~ 11

Author(s):

Dongwhane Lee ◽

Sung Hyuk Heo ◽

Sung-Sang Yoon ◽

Dae-Il Chang ◽

Sangeui Lee ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Predictive Factors ◽

Sleep Disturbances

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Detection of prospective memory deficits in mild cognitive impairment of suspected Alzheimer’s disease etiology using a novel event-based prospective memory task

Journal of the International Neuropsychological Society ◽

10.1017/s1355617708090127 ◽

2009 ◽

Vol 15 (1) ◽

pp. 154-159 ◽

Cited By ~ 50

Author(s):

ALBERTO BLANCO-CAMPAL ◽

ROBERT F. COEN ◽

BRIAN A. LAWLOR ◽

JOSEPH B. WALSH ◽

TERESA E. BURKE

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Prospective Memory ◽

Small Sample ◽

Cutoff Score ◽

Convenience Sample ◽

Disease Etiology ◽

Event Based

AbstractWe investigated the relative discriminatory efficacy of an event-based prospective memory (PM) task, in which specificity of the instructions and perceptual salience of the PM cue were manipulated, compared with two widely used retrospective memory (RM) tests (Rivermead Paragraph Recall Test and CERAD-Word List Test), when detecting mild cognitive impairment of suspected Alzheimer’s disease etiology (MCI-AD) (N = 19) from normal controls (NC) (N = 21). Statistical analyses showed high discriminatory capacity of the PM task for detecting MCI-AD. The Non-Specific-Non-Salient condition proved particularly useful in detecting MCI-AD, possibly reflecting the difficulty of the task, requiring more strategic attentional resources to monitor for the PM cue. With a cutoff score of <4/10, the Non-Specific-Non-Salient condition achieved a sensitivity = 84%, and a specificity = 95%, superior to the most discriminative RM test used (CERAD-Total Learning: sensitivity = 83%; specificity = 76%). Results suggest that PM is an early sign of memory failure in MCI-AD and may be a more pronounced deficit than retrospective failure, probably reflecting the greater self-initiated retrieval demands involved in the PM task used. Limitations include the relatively small sample size, and the use of a convenience sample (i.e. memory clinic attenders and healthy active volunteers), reducing the generalizability of the results, which should be regarded as preliminary. (JINS, 2009, 15, 154–159.)

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