Mild Cognitive Impairment: A Prospective Community Study

轻度认知障碍：一项前瞻性社区研究。 轻度认知障碍(MCI)是介于正常衰老和正常衰老之间的认知状态 痴呆症。MCI存在多个术语、定义和标准集。在专科临床环境中，MCI 几乎一致地以很高的比率进展为痴呆症，并被认为是前驱症状 痴呆症。在社区研究中，MCI是一种更不同的状态，风险较低 进展为痴呆症，相当大的比例仍然只有轻微的损害，甚至 恢复正常认知。我们需要更好地理解谁会进步，谁不会进步 MCI到痴呆症，因此诊断标准可以基于社区的预测有效性，网址为 规模大，使个体可以更恰当地针对性地进行预防和早期干预。 这份申请是为了更新一项新的研究，该研究是从一个社区中随机抽取的一个队列进行的。 宾夕法尼亚州西部。2008年，该队列完成了2036名65岁以上老人的招募工作，其中大多数 其中一些人进行了APOE基因分型。我们以重叠的两年时间进行年度跟踪评估 循环。这项研究的目的是从头开始关注MCI而不是更严重的损伤 典型的痴呆症。评估协议允许应用许多现有的分类 MCI的系统和标准集，从而允许比较它们对痴呆症的预测值 在后续行动中。除了标准标准，我们还制定了可靠的认知分类 相对于我们队列中的标准数据，以及基于Web的专家诊断新方法 达成共识。相关的临床和生物学指标被评估为协变量和预测因子。这个 主要结果指标是进展为痴呆症；我们还检查了纵向变化指标 临床痴呆症分级、个体认知域、功能损害和其他评估。 我们现在建议将队列再跟踪五年，以便有足够的个人将 经历这些变化，为预测MCI进展为痴呆症的关键分析提供动力。新的 测量方法包括对250名个体进行结构磁共振脑成像，以确定 皮质和局部萎缩以及白质高信号的测量改善了对 本社区样本中的痴呆症；储存血清中6种血管和炎症标志物的分析， 以及对所有储存的DNA中与阿尔茨海默病和中风相关的13个新的SNPs进行基因分型。这些 新措施反映了对血管风险因素的更大重视。继续跟进这口井- 具有特征的老龄化队列将提高对MCI在人口中的异质性的理解 大的，并有助于确定MCI结果的可靠预测因素。

Mild Cognitive Impairment: a Prospective Community Study. Mild Cognitive Impairment (MCI) is the cognitive state intermediate between normal aging and dementia. Multiple terms, definitions, and criterion sets exist for MCI. In specialty clinical settings, MCI almost uniformly progresses to dementia at a high rate, and is assumed to represent prodromal dementia. In community studies, MCI is a more heterogeneous state with less elevated risk of progression to dementia, and with substantial proportions remaining only mildly impaired or even reverting to normal cognition. A better understanding is needed of who will and will not progress from MCI to dementia, so that diagnostic criteria can be based on predictive validity in the community at large, and so that individuals can be more appropriately targeted for prevention and early intervention. This application is for renewal of a new study of a cohort randomly selected from a community in Western PA. In 2008, the cohort completed recruitment of 2036 individuals aged 65+, and the majority of them have had APOE genotyping. We conduct annual followup assessments in overlapping 2-year cycles. This study was designed de novo to focus on MCI rather than on the more severe impairments typical of dementia. The assessment protocol allows the application of many extant classification systems and criterion sets for MCI, thus allowing their predictive values for dementia to be compared during followup. Besides the standard criteria, we have also developed reliable cognitive classifications relative to normative data from our cohort, and a novel web-based approach to expert diagnostic consensus. Relevant clinical and biological measures are assessed as covariates and predictors. The primary outcome measure is progression to dementia; we also examine longitudinal change measures in clinical dementia rating, individual cognitive domains, functional impairment, and other assessments. We now propose to follow the cohort for a further five years, so that sufficient individuals will undergo these changes to power the key analyses predicting progression to dementia from MCI. New measures include structural MRI brain imaging in 250 individuals to determine the extent to which measures of cortical and regional atrophy and white matter hyperintensities improve prediction of dementia in this community sample; assays of 6 vascular and inflammatory markers in stored serum, and genotyping for 13 new SNPs associated with Alzheimer's disease and stroke in all stored DNA. These new measures reflect an expanded emphasis on vascular risk factors. Continued followup of this well- characterized aging cohort will improve understanding of the heterogeneity of MCI in the population at large, and help identify reliable predictors of the outcomes of MCI.