Henry Brodaty1, Liesbeth Aerts2, John D Crawford3, Megan Heffernan2, Nicole A Kochan4, Simone Reppermund5, Kristan Kang3, Kate Maston3, Brian Draper6, Julian N Trollor5, Perminder S Sachdev6. 1. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia. Electronic address: h.brodaty@unsw.edu.au. 2. Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, University of New South Wales, Sydney, Australia. 3. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia. 4. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia. 5. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia. 6. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia.
Abstract
OBJECTIVE: Mild cognitive impairment (MCI) is considered an intermediate stage between normal aging and dementia. It is diagnosed in the presence of subjective cognitive decline and objective cognitive impairment without significant functional impairment, although there are no standard operationalizations for each of these criteria. The objective of this study is to determine which operationalization of the MCI criteria is most accurate at predicting dementia. DESIGN: Six-year longitudinal study, part of the Sydney Memory and Ageing Study. SETTING: Community-based. PARTICIPANTS: 873 community-dwelling dementia-free adults between 70 and 90 years of age. Persons from a non-English speaking background were excluded. MEASUREMENTS: Seven different operationalizations for subjective cognitive decline and eight measures of objective cognitive impairment (resulting in 56 different MCI operational algorithms) were applied. The accuracy of each algorithm to predict progression to dementia over 6 years was examined for 618 individuals. RESULTS: Baseline MCI prevalence varied between 0.4% and 30.2% and dementia conversion between 15.9% and 61.9% across different algorithms. The predictive accuracy for progression to dementia was poor. The highest accuracy was achieved based on objective cognitive impairment alone. Inclusion of subjective cognitive decline or mild functional impairment did not improve dementia prediction accuracy. CONCLUSIONS: Not MCI, but objective cognitive impairment alone, is the best predictor for progression to dementia in a community sample. Nevertheless, clinical assessment procedures need to be refined to improve the identification of pre-dementia individuals.
OBJECTIVE: Mild cognitive impairment (MCI) is considered an intermediate stage between normal aging and dementia. It is diagnosed in the presence of subjective cognitive decline and objective cognitive impairment without significant functional impairment, although there are no standard operationalizations for each of these criteria. The objective of this study is to determine which operationalization of the MCI criteria is most accurate at predicting dementia. DESIGN: Six-year longitudinal study, part of the Sydney Memory and Ageing Study. SETTING: Community-based. PARTICIPANTS: 873 community-dwelling dementia-free adults between 70 and 90 years of age. Persons from a non-English speaking background were excluded. MEASUREMENTS: Seven different operationalizations for subjective cognitive decline and eight measures of objective cognitive impairment (resulting in 56 different MCI operational algorithms) were applied. The accuracy of each algorithm to predict progression to dementia over 6 years was examined for 618 individuals. RESULTS: Baseline MCI prevalence varied between 0.4% and 30.2% and dementia conversion between 15.9% and 61.9% across different algorithms. The predictive accuracy for progression to dementia was poor. The highest accuracy was achieved based on objective cognitive impairment alone. Inclusion of subjective cognitive decline or mild functional impairment did not improve dementia prediction accuracy. CONCLUSIONS: Not MCI, but objective cognitive impairment alone, is the best predictor for progression to dementia in a community sample. Nevertheless, clinical assessment procedures need to be refined to improve the identification of pre-dementia individuals.
Authors: Hannah Derrig; Louise M Lavrencic; Gerald A Broe; Brian Draper; Robert G Cumming; Gail Garvey; Thi Yen Hill; Gail Daylight; Simon Chalkley; Holly Mack; Danielle Lasschuit; Kim Delbaere; Kylie Radford Journal: Alzheimers Dement (N Y) Date: 2020-08-24
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Authors: Andrea M Weinstein; Swathi Gujral; Meryl A Butters; Christopher R Bowie; Corinne E Fischer; Alastair J Flint; Nathan Herrmann; James L Kennedy; Linda Mah; Shima Ovaysikia; Bruce G Pollock; Tarek K Rajji; Benoit H Mulsant Journal: Am J Geriatr Psychiatry Date: 2021-04-14 Impact factor: 4.105
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