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Medial temporal atrophy but not memory deficit predicts progression to dementia in patients with mild cognitive impairment

IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico, Scientific Institute for Research and Care), San Giovanni di Dio–FBF, Brescia, Italy

Correspondence to:
Correspondence to:
C Geroldi
Psychogeriatrics Ward, LENITEM—Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS San Giovanni di Dio FBF—The National Center for Research and Care of Alzheimer’s Disease, via Pilastroni 4, 25125 Brescia, Italy;cgeroldi{at}fatebenefratelli.it

Background: The diagnosis of mild cognitive impairment (MCI) is clinically unhelpful, as many patients with MCI develop dementia but many do not.

Objective: To identify clinical instruments easily applicable in the clinical routine that might be useful to predict progression to dementia in patients with MCI assessed in the outpatient facility of a memory clinic.

Participants and methods: 52 dementia-free patients (mean (standard deviation) age 70 (6) years; 56% women) with MCI, and 65 healthy controls (age 69 (6) years; 54% women) underwent brain magnetic resonance scan with standardised visual assessment of medial temporal atrophy (MTA) and subcortical cerebrovascular lesions (SVLs). Follow-up assessment occurred 15.4 (SD 3.4) months after baseline to detect incident dementia and improvement, defined as normal neuropsychological performance on follow-up.

Results: Patients were classified into three groups according to the presence of memory disturbance only (MCI Mem), other neuropsychological deficits (MCI Oth) or both (MCI Mem+). MCI Mem and Mem+ showed MTA more frequently (31% and 47% v 5% and 14% of controls and MCI Oth, p<0.001). 11 patients developed dementia (annual rate 16.5%) and 7 improved on follow-up. The only independent predictor of progression was MTA (odds ratio (OR) 7.1, 95% confidence interval (CI) 1.4 to 35.0), whereas predictors of improvement were the absence of memory impairment (OR 18.5, 95% CI 2.0 to 171.3) and normal MRI scan (OR 10.0, 95% CI 1.7 to 60.2).

Conclusion: Neuropsychological patterns identify groups of patients with MCI showing specific clinical features and risk of progression to dementia. MTA clinically rated with a visual scale is the most relevant predictor of progression and improvement.

Abbreviations: CDR, Clinical Dementia Rating; MCI, mild cognitive impairment; MCI Mem, MCI with isolated memory deficit; MCI Mem+, MCI memory associated with non-memory deficit; MCI Oth, mild cognitive impairment with non-memory deficits; MMSE, Mini-Mental State Examination; MTA, medial temporal atrophy; SVL, subcortical cerebrovascular lesion

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