Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal
Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal
复制标题
DOI：
10.1212/wnl.0000000000000055
复制
发表时间：
2014-01-28
期刊：
影响因子：
9.9
通讯作者：
Petersen, Ronald C.
中科院分区：
文献类型：
--
作者：
Roberts, Rosebud O.;Knopman, David S.;Petersen, Ronald C.
目的：估计从轻度认知功能障碍（MCI）进展为痴呆和从MCI逆转为认知正常（CN）的人口为基础的coherents.Methods：参与者（n = 534，年龄70岁及以上）参加了前瞻性马约诊所老龄化研究进行了评估，在基线和每15个月，以确定事件MCI或dementials.Results：在中位数为5.1年的随访，153 534（28.7%）与流行或事件MCI进展为痴呆（71.3每1,000人年）。痴呆的累积发病率在1年时为5.4%，在2年时为16.1%，在3年时为23.4%，在4年时为31.1%，在5年时为42.5%。与CN受试者相比，MCI患者痴呆的风险升高（风险比[HR] 23.2，p < 0.001）。38%（n = 201）的MCI参与者恢复为CN（175.0/1000人-年），但65%随后发展为MCI或痴呆;与CN受试者相比，HR为6.6（p < 0.001）。在携带APOE β 4等位基因（HR 0.53，p < 0.001）、临床痴呆评定量表-方框总和较高（HR 0.56，p < 0.001）和认知功能较差（HR 0.56，p < 0.001）的受试者中，逆转风险降低。遗忘型MCI（HR 0.70，p = 0.02）和多领域MCI（HR 0.61，p = 0.003）的受试者的风险也有所降低。结论：MCI病例，包括那些恢复到CN的病例，进展为痴呆的风险很高。这表明MCI的诊断在任何时候都有预后价值。
Objective:To estimate rates of progression from mild cognitive impairment (MCI) to dementia and of reversion from MCI to being cognitively normal (CN) in a population-based cohort.Methods:Participants (n = 534, aged 70 years and older) enrolled in the prospective Mayo Clinic Study of Aging were evaluated at baseline and every 15 months to identify incident MCI or dementia.Results:Over a median follow-up of 5.1 years, 153 of 534 participants (28.7%) with prevalent or incident MCI progressed to dementia (71.3 per 1,000 person-years). The cumulative incidence of dementia was 5.4% at 1 year, 16.1% at 2, 23.4% at 3, 31.1% at 4, and 42.5% at 5 years. The risk of dementia was elevated in MCI cases (hazard ratio [HR] 23.2, p < 0.001) compared with CN subjects. Thirty-eight percent (n = 201) of MCI participants reverted to CN (175.0/1,000 person-years), but 65% subsequently developed MCI or dementia; the HR was 6.6 (p < 0.001) compared with CN subjects. The risk of reversion was reduced in subjects with an APOE epsilon 4 allele (HR 0.53, p < 0.001), higher Clinical Dementia Rating Scale-Sum of Boxes (HR 0.56, p < 0.001), and poorer cognitive function (HR 0.56, p < 0.001). The risk was also reduced in subjects with amnestic MCI (HR 0.70, p = 0.02) and multidomain MCI (HR 0.61, p = 0.003).Conclusions:MCI cases, including those who revert to CN, have a high risk of progressing to dementia. This suggests that diagnosis of MCI at any time has prognostic value.