Mild Cognitive Impairment: A Prospective Community Study

描述(由申请人提供)：相当数量的老年人看起来既不是认知完好无损也不是精神错乱，但有介于这两个状态之间的轻微损害。术语认知损害，无痴呆(CIND)已被用来描述这一广泛的群体，而不考虑病因。对CIND亚组的描述有几个术语，包括轻度认知损害(MCI)，通常用于描述痴呆障碍的前驱症状或风险状态。虽然在临床上有用，但这些术语、概念和标准在更广泛的社区环境中不太可靠，在那里它们似乎识别不稳定和不同的类别。然而，考虑到那些最有可能进展为痴呆症的人越来越有可能采取二级预防/早期干预策略，识别那些真正患有早期痴呆障碍的人的重要性怎么强调都不为过。 这项修订后的申请是为了在匹兹堡(宾夕法尼亚州)附近开展一个新的流行病学项目。具体地说，我们将描述CIND/MCI和相关实体的分布、它们的相关特征、它们随时间的结果以及这些结果的预测因素。将招募约2100名按年龄分层的随机社区样本，并使用认知、功能和其他与健康相关的措施进行筛查，以确定哪些非痴呆者存在认知障碍。其中，我们将确定符合MCI操作标准的遗忘型和其他品种的亚组。参与者将根据不同群体目前使用的多个可能重叠的图式进一步分类。亚组还将根据人口统计、临床和生物变量来描述，这些变量可以预测结果和/或具有诊断意义。年度跟踪评估将跟踪认知和功能能力的变化，并确定向临床状态的转变，包括阿尔茨海默病和其他痴呆障碍。对这些预期收集的数据的分析将允许根据结果定义亚组，从而允许对各种形式的轻度认知障碍的临床和研究标准进行经验上的改进。

DESCRIPTION (provided by applicant): A substantial number of older adults appear neither cognitively intact nor demented, but have minimal impairments that are intermediate between these two states. The term Cognitive Impairment, No Dementia (CIND) has been used to describe this broad group, regardless of etiology. Subgroups of CIND have been described using several terms, including Mild Cognitive Impairment (MCI) often used to describe a prodromal or risk state for dementing disorders. While clinically useful, these terms, concepts, and criteria are less reliable in the broader community setting, where they seem to identify unstable and heterogeneous categories. Yet, the importance of identifying those with true incipient dementing disorders cannot be overstated, given the growing likelihood of secondary prevention/ early intervention strategies in those most likely to progress to dementia. This revised application is for a new epidemiological project to be carried out near Pittsburgh (PA). Specifically, we will describe the distribution of CIND/ MCI and related entities, their associated features, their outcomes over time, and the predictors of these outcomes. An age-stratified random community sample of approximately 2,100 will be recruited and screened using cognitive, functional, and other health-related measures, to identify the non-demented who are cognitively impaired. Among them, we will identify subgroups meeting operational criteria for MCI of amnestic and other varieties. Participants will be further classified according to multiple, potentially overlapping, schema which are in currently use by different groups. Subgroups will be also characterized with regard to demographic, clinical, and biological variables which may predict outcomes and/or have diagnostic significance. Annual follow-up assessments will track changes in cognitive and functional ability and identify transitions to clinical states including Alzheimer's disease and other dementing disorders. Analysis of these prospectively gathered data will allow subgroups to be defined according to outcome, and thus permit the empirical refinement of clinical and research criteria for various forms of mild cognitive impairment.