Dement Neurocogn Disord.  2016 Sep;15(3):68-74. 10.12779/dnd.2016.15.3.68.

Clinical Predictors for Mild Cognitive Impairment Progression in a Korean Cohort

• Shim YS
• Yang DW
• Yoon B
• Lee Y
• Hong CH
• Seo SW
• Yoon SJ
• Jeong JH
• Park MH
• Choi SH
• Kim SY

• KMID: 2442848
• DOI: http://doi.org/10.12779/dnd.2016.15.3.68

Abstract

BACKGROUND AND PURPOSE
Patients with mild cognitive impairment (MCI) and their caregivers are concerned with the likelihood and time course of progression to dementia. This study was performed to identify the clinical predictors of the MCI progression in a Korean registry, and investigated the effects of medications without evidence, frequently prescribed in clinical practice.
METHODS
Using a Korean cohort that included older adults with MCI who completed at least one follow-up visit, clinical characteristics and total medical expenses including prescribed medications were compared between two groups: progressed to dementia or not. Cox proportional hazards regression analysis was conducted.
RESULTS
During the mean 1.42±0.72 years, 215 (27.63%) of 778 participants progressed to dementia. The best predictors were age [hazard ratio (HR), 1.036; 95% confidence interval (CI), 1.006-1.067; p=0.018], apolipoprotein ε4 allele (HR, 2.247; 95% CI, 1.512-3.337; p<0.001), Clinical Dementia Rating scale-sum of boxes scores (HR, 1.367; 95% CI, 1.143-1.636; p=0.001), Instrumental Activities of Daily Living scores (HR, 1.035; 95% CI, 1.003-1.067; p=0.029), and lower Mini-Mental State Examination scores (HR, 0.892; 95% CI, 0.839-0.949; p<0.001). Total medical expenses were not different.
CONCLUSIONS
Our data are in accordance with previous reports about clinical predictors for the progression from MCI to dementia. Total medical expenses were not different between groups with and without progression.

Keyword

cholinesterase inhibitors; dementia; mild cognitive impairment; predictors

MeSH Terms

Activities of Daily Living
Adult
Alleles
Apolipoproteins
Caregivers
Cholinesterase Inhibitors
Cohort Studies*
Dementia
Follow-Up Studies
Humans
Mild Cognitive Impairment*
Apolipoproteins
Cholinesterase Inhibitors

Reference

1. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999; 56:303–308.

2. Busse A, Hensel A, Gühne U, Angermeyer MC, Riedel-Heller SG. Mild cognitive impairment: long-term course of four clinical subtypes. Neurology. 2006; 67:2176–2185.

3. Manly JJ, Tang MX, Schupf N, Stern Y, Vonsattel JP, Mayeux R. Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol. 2008; 63:494–506.

4. Grundman M, Petersen RC, Ferris SH, Thomas RG, Aisen PS, Bennett DA, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol. 2004; 61:59–66.

5. Dickerson BC, Sperling RA, Hyman BT, Albert MS, Blacker D. Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment. Arch Gen Psychiatry. 2007; 64:1443–1450.

6. Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005; 352:2379–2388.

7. Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health. 2014; 14:643.

8. Cooper C, Li R, Lyketsos C, Livingston G. Treatment for mild cognitive impairment: systematic review. Br J Psychiatry. 2013; 203:255–264.

9. Karakaya T, Fußer F, Schröder J, Pantel J. Pharmacological treatment of mild cognitive impairment as a prodromal syndrome of Alzheimer's disease. Curr Neuropharmacol. 2013; 11:102–108.

10. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004; 256:183–194.

11. Kang Y, Na DL, Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997; 15:300–308.

12. Park HK, Na DL, Han SH, Kim JY, Cheong HK, Kim SY, et al. Clinical characteristics of a nationwide hospital-based registry of mild-to-moderate Alzheimer's disease patients in Korea: a CREDOS (Clinical Research Center for Dementia of South Korea) study. J Korean Med Sci. 2011; 26:1219–1226.

13. Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993; 43:2412–2414.

14. Pantoni L, Inzitari D. Hachinski's ischemic score and the diagnosis of vascular dementia: a review. Ital J Neurol Sci. 1993; 14:539–546.

15. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-1983; 17:37–49.

16. Ku HM, Kim JH, Kwon EJ, Kim SH, Lee HS, Ko HJ, et al. A study on the reliability and validity of Seoul-Instrumental Activities of Daily Living (S-IADL). J Korean Neuropsychiatr Assoc. 2004; 43:189–199.

17. Kang Y, Na DL. Seoul Neuropsychological Screening Battery (SNSB). 1st ed. Incheon: Human Brain Research & Consulting Co.;2003.

18. Noh Y, Lee Y, Seo SW, Jeong JH, Choi SH, Back JH, et al. A new classification system for ischemia using a combination of deep and periventricular white matter hyperintensities. J Stroke Cerebrovasc Dis. 2014; 23:636–642.

19. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984; 34:939–944.

20. Román GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993; 43:250–260.

21. McKeith IG, Dickson DW, Lowe J, Emre M, O'Brien JT, Feldman H, et al. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005; 65:1863–1872.

22. Knopman DS, Kramer JH, Boeve BF, Caselli RJ, Graff-Radford NR, Mendez MF, et al. Development of methodology for conducting clinical trials in frontotemporal lobar degeneration. Brain. 2008; 131(Pt 11):2957–2968.

23. Pankratz VS, Roberts RO, Mielke MM, Knopman DS, Jack CR Jr, Geda YE, et al. Predicting the risk of mild cognitive impairment in the Mayo Clinic Study of Aging. Neurology. 2015; 84:1433–1442.

24. Kim S, Kim MJ, Kim S, Kang HS, Lim SW, Myung W, et al. Gender differences in risk factors for transition from mild cognitive impairment to Alzheimer's disease: A CREDOS study. Compr Psychiatry. 2015; 62:114–122.

25. Feldman HH, Ferris S, Winblad B, Sfikas N, Mancione L, He Y, et al. Effect of rivastigmine on delay to diagnosis of Alzheimer's disease from mild cognitive impairment: the InDDEx study. Lancet Neurol. 2007; 6:501–512.

26. Winblad B, Gauthier S, Scinto L, Feldman H, Wilcock GK, Truyen L, et al. Safety and efficacy of galantamine in subjects with mild cognitive impairment. Neurology. 2008; 70:2024–2035.

27. Doody RS, Ferris SH, Salloway S, Sun Y, Goldman R, Watkins WE, et al. Donepezil treatment of patients with MCI: a 48-week randomized, placebo-controlled trial. Neurology. 2009; 72:1555–1561.

28. Han JW, Kim TH, Lee SB, Park JH, Lee JJ, Huh Y, et al. Predictive validity and diagnostic stability of mild cognitive impairment subtypes. Alzheimers Dement. 2012; 8:553–559.

29. Olazarán J, Torrero P, Cruz I, Aparicio E, Sanz A, Mula N, et al. Mild cognitive impairment and dementia in primary care: the value of medical history. Fam Pract. 2011; 28:385–392.

30. Koepsell TD, Monsell SE. Reversion from mild cognitive impairment to normal or near-normal cognition: risk factors and prognosis. Neurology. 2012; 79:1591–1598.