Mild Cognitive Impairment: A Prospective Community Study

轻度认知障碍：前瞻性社区研究。 轻度认知障碍（MCI）是介于正常衰老和轻度认知障碍之间的认知状态。 痴呆MCI存在多个术语、定义和标准集。在专业临床环境中，MCI 几乎一致地以高速率进展为痴呆，并被认为是前驱症状 痴呆在社区研究中，MCI是一种异质性更强的状态， 进展为痴呆，并且相当大的比例仅保持轻度受损或甚至 恢复正常认知。需要更好地了解谁会和谁不会从 MCI到痴呆，因此诊断标准可以基于社区的预测有效性， 因此，可以更适当地针对个人进行预防和早期干预。 本申请是为了更新一项新的研究，该研究的队列是从以下社区随机选择的： 西宾夕法尼亚州。2008年，该队列完成了对2036名65岁以上的人的招募，其中大多数人都是成年人。 他们中的人进行了APOE基因分型。我们在重叠的2年内进行年度随访评估， 自行车.这项研究是重新设计的，重点是MCI，而不是更严重的损害 典型的痴呆症评估协议允许应用许多现存的分类 MCI的系统和标准集，从而可以比较它们对痴呆症的预测值 在后续。除了标准的标准，我们还开发了可靠的认知分类 相对于我们队列的规范性数据，以及一种新的基于网络的专家诊断方法， 共识相关的临床和生物学指标作为协变量和预测因子进行评估。的 主要结果测量是进展为痴呆;我们还检查了 临床痴呆评级、个体认知领域、功能损害和其他评估。 我们现在建议再跟踪该队列五年，以便有足够的人 经历这些变化来支持预测MCI进展为痴呆的关键分析。新 措施包括在250人的结构MRI脑成像，以确定在何种程度上， 皮质和区域萎缩和白色高信号的测量可提高 该社区样本中的痴呆;在储存的血清中测定6种血管和炎症标记物， 并对所有储存的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 新的措施反映了对血管危险因素的进一步重视。继续跟进这口井- 特征化的老龄化队列将提高对MCI在人群中异质性的理解， 大，并帮助确定可靠的预测MCI的结果。

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.