Neuropsychological Prediction of Conversion to Alzheimer Disease in Patients With Mild Cognitive Impairment

• DOI: 10.1001/archpsyc.63.8.916
• Publication Date: 2006-08-07T20:27:44Z
• Authors: Matthias H. Tabert; Jennifer J. Manly; Xinhua Liu; Gregory H. Pelton; Sara Rosenblum; Marni Jacobs; Diana Zamora; Madeleine Goodkind; Karen Bell; Yaakov Stern; D. P. Devanand
• Keywords: Male; Older people--Mental health; 610; Comorbidity; Neuropsychological Tests; Severity of Illness Index; 03 medical and health sciences; Cognition; 0302 clinical medicine; Alzheimer Disease; Predictive Value of Tests; Risk Factors; Neuropsychology; Humans; Longitudinal Studies; Aged; Memory Disorders; FOS: Clinical medicine; Neurosciences; Mild cognitive impairment; Alzheimer's disease; Prognosis; Survival Analysis; 3. Good health; Disease Progression; Regression Analysis; Female; Amnestic mild cognitive impairment; Dementia; Mental health; Cognition Disorders; Gerontology

Context: The likelihood of conversion to Alzheimer disease (AD) in mild cognitive impairment (MCI) and the “optimal” early markers of conversion need to be established. Objectives: To evaluate conversion rates to AD in subtypes of MCI and to identify neuropsychological measures most predictive of the time to conversion. Design: Patients were followed up semiannually and controls annually. Subtypes of MCI were determined by using demographically adjusted regression norms on neuropsychological tests. Survival analysis was used to identify the most predictive neuropsychological measures. Setting: Memory disorders clinic. Participants: One hundred forty-eight patients reporting memory problems and 63 group-matched controls. Main Outcome Measure: A consensus diagnosis of probable AD. Results: At baseline, 108 patients met criteria for amnestic MCI: 87 had memory plus other cognitive domain deficits and 21 had pure memory deficits. The mean duration of follow-up for the 148 patients was 46.6 ± 24.6 months. In 3 years, 32 (50.0%) of 64 amnestic-“plus” and 2 (10.0%) of 20 “pure” amnestic patients converted to AD (P = .001). In 148 patients, of 5 a priori predictors, the percent savings from immediate to delayed recall on the Selective Reminding Test and the Wechsler Adult Intelligence Scale–Revised Digit Symbol Test were the strongest predictors of time to conversion. From the entire neuropsychological test battery, a stepwise selection procedure retained 2 measures in the final model: total immediate recall on the Selective Reminding Test (odds ratio per 1-point decrease, 1.10; 95% confidence interval, 1.05-1.14; P