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Vol. 26, No. 2, 2008
Issue release date: September 2008
Free Access
Dement Geriatr Cogn Disord 2008;26:187–192
(DOI:10.1159/000151635)

Clinical Features of Mild Cognitive Impairment Differ in the Research and Tertiary Clinic Settings

Jicha G.A.a, c · Abner E.c · Schmitt F.A.a, c · Cooper G.E.a, c · Stiles N.c, d · Hamon R.c · Carr S.c · Smith C.D.a, c · Markesbery W.R.a-c
Departments of aNeurology and bPathology, cAlzheimer’s Disease Center, and dPhysical Medicine and Rehabilitation, University of Kentucky College of Medicine, Lexington, Ky., USA
email Corresponding Author

Abstract

Objective: Comparative analysis of subjects with mild cognitive impairment (MCI) diagnosed in a primary research setting and those seen in a tertiary care memory disorders clinic. Methods: Subjects who received a diagnosis of MCI between July 1, 2005, and December 31, 2006, in a longitudinal research study of normal cognition (n = 48) and patients diagnosed in a tertiary care referral clinic (n = 34) were evaluated using similar methodologies. Comparative analyses of detailed medical, neurological and neuropsychological data are presented. Results: The diagnosis of MCI was not accepted by 13 of 48 subjects (27%) classified as MCI in the primary research setting. Nondegenerative, potentially treatable causes of cognitive decline were found in 3 of 34 subjects (9%) seen in the tertiary referral clinic and in 11 of 35 subjects (31%) identified as MCI in the primary research setting (p = 0.02, Fisher’s exact test). MCI subjects identified in the primary research setting were older than those referred to the memory clinic (mean ± SD, 79.7 ± 7.0 vs. 71.5 ± 9.0 years, p < 0.0001, t test) and had more years of education (16.0 ± 3.2 vs. 13.6 ± 4.2 years, p < 0.01, t test). MCI subjects in the primary research setting appeared to be in a milder stage of disease, characterized by higher Mini-Mental State Examination scores (28.2 ± 1.8 vs. 25.7 ± 1.8, p < 0.0001), and a tendency towards single domain involvement, predominantly memory (mean number of domains involved, 1.0 vs. 2.5, p < 0.0001). More advanced stages of MCI, seen in the tertiary referral population, had additional involvement of attention (p < 0.0001, Fisher’s exact test) and visuospatial domains (p < 0.0002, Fisher’s exact test). Semiquantitative grading of hippocampal and medial temporal lobe atrophy did not differ between groups (p = 0.81, Mann-Whitney U test). Conclusions: The diagnosis of MCI may be unwelcome in naïve persons. Remedial causes of MCI should be actively investigated. Demographic and clinical characteristics of MCI differ between research subjects and patients referred to a tertiary care clinic.


 goto top of outline Key Words

  • Mild cognitive impairment
  • Alzheimer’s disease
  • Cognitive domain

 goto top of outline Abstract

Objective: Comparative analysis of subjects with mild cognitive impairment (MCI) diagnosed in a primary research setting and those seen in a tertiary care memory disorders clinic. Methods: Subjects who received a diagnosis of MCI between July 1, 2005, and December 31, 2006, in a longitudinal research study of normal cognition (n = 48) and patients diagnosed in a tertiary care referral clinic (n = 34) were evaluated using similar methodologies. Comparative analyses of detailed medical, neurological and neuropsychological data are presented. Results: The diagnosis of MCI was not accepted by 13 of 48 subjects (27%) classified as MCI in the primary research setting. Nondegenerative, potentially treatable causes of cognitive decline were found in 3 of 34 subjects (9%) seen in the tertiary referral clinic and in 11 of 35 subjects (31%) identified as MCI in the primary research setting (p = 0.02, Fisher’s exact test). MCI subjects identified in the primary research setting were older than those referred to the memory clinic (mean ± SD, 79.7 ± 7.0 vs. 71.5 ± 9.0 years, p < 0.0001, t test) and had more years of education (16.0 ± 3.2 vs. 13.6 ± 4.2 years, p < 0.01, t test). MCI subjects in the primary research setting appeared to be in a milder stage of disease, characterized by higher Mini-Mental State Examination scores (28.2 ± 1.8 vs. 25.7 ± 1.8, p < 0.0001), and a tendency towards single domain involvement, predominantly memory (mean number of domains involved, 1.0 vs. 2.5, p < 0.0001). More advanced stages of MCI, seen in the tertiary referral population, had additional involvement of attention (p < 0.0001, Fisher’s exact test) and visuospatial domains (p < 0.0002, Fisher’s exact test). Semiquantitative grading of hippocampal and medial temporal lobe atrophy did not differ between groups (p = 0.81, Mann-Whitney U test). Conclusions: The diagnosis of MCI may be unwelcome in naïve persons. Remedial causes of MCI should be actively investigated. Demographic and clinical characteristics of MCI differ between research subjects and patients referred to a tertiary care clinic.

Copyright © 2008 S. Karger AG, Basel


 goto top of outline References
  1. Bruscoli M, Lovestone S: Is MCI really just early dementia? A systematic review of conversion studies. Int Psychogeriatr 2004;16:129–140.
  2. Busse A, Bischkopf J, Riedel-Heller SG, Angermeyer MC: Subclassifications for mild cognitive impairment: prevalence and predictive validity. Psychol Med 2003;33:1029–1038.
  3. Jicha GA, Petersen RC: Mild cognitive impairment; in Growdon JH, Rossor M (eds): The Dementias 2. Amsterdam, Elsevier, 2007.
  4. Lambon Ralph MA, Patterson K, Graham N, Dawson K, Hodges JR: Homogeneity and heterogeneity in mild cognitive impairment and Alzheimer’s disease: a cross-sectional and longitudinal study of 55 cases. Brain 2003;126:2350–2362.
  5. Lopez OL, Kuller LH, Becker JT, et al: Incidence of dementia in mild cognitive impairment in the cardiovascular health study cognition study. Arch Neurol 2007;64:416–420.
  6. Lopponen M, Raiha I, Isoaho R, Vahlberg T, Kivela SL: Diagnosing cognitive impairment and dementia in primary health care – a more active approach is needed. Age Ageing 2003;32:606–612.
  7. Panza F, Capurso C, D’Introno A, Colacicco AM, Capurso A, Solfrizzi V: Heterogeneity of mild cognitive impairment and other predementia syndromes in progression to dementia. Neurobiol Aging 2007;28:1631–1632, discussion 1633–1634.
  8. Petersen RC: The current status of mild cognitive impairment – what do we tell our patients? Nat Clin Pract Neurol 2007;3:60–61.
  9. Petersen RC: Mild cognitive impairment: current research and clinical implications. Semin Neurol2007;27:22–31.
  10. Portet F, Ousset PJ, Visser PJ, et al: Mild cognitive impairment (MCI) in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consortium on Alzheimer’s Disease. J Neurol Neurosurg Psychiatry 2006;77:714–718.
  11. Stephan BC, Matthews FE, McKeith IG, Bond J, Brayne C: Early cognitive change in the general population: how do different definitions work? J Am Geriatr Soc 2007;55:1534–1540.
  12. Tognoni G, Ceravolo R, Nucciarone B, et al: From mild cognitive impairment to dementia: a prevalence study in a district of Tuscany, Italy. Acta Neurol Scand2005;112:65–71.
  13. Winblad B, Palmer K, Kivipelto M, et al: Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240–246.
  14. Yaffe K, Petersen RC, Lindquist K, Kramer J, Miller B: Subtype of mild cognitive impairment and progression to dementia and death. Dement Geriatr Cogn Disord 2006;22:312–319.
  15. Levitt AJ, Karlinsky H: Folate, vitamin B12 and cognitive impairment in patients with Alzheimer’s disease. Acta Psychiatr Scand 1992;86:301–305.
  16. Schmitt FA, Wetherby MM, Wekstein DR, Dearth CM, Markesbery WR: Brain donation in normal aging: procedures, motivations, and donor characteristics from the Biologically Resilient Adults in Neurological Studies (BRAiNS) Project. Gerontologist 2001;41:716–722.
  17. Knopman DS, DeKosky ST, Cummings JL, et al: Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1143–1153.
  18. Vermersch P, Leys D, Scheltens P, Barkhof F: Visual rating of hippocampal atrophy: correlation with volumetry. J Neurol Neurosurg Psychiatry 1994;57:1015.
  19. Wahlund LO, Julin P, Johansson SE, Scheltens P: Visual rating and volumetry of the medial temporal lobe on magnetic resonance imaging in dementia: a comparative study. J Neurol Neurosurg Psychiatry2000;69:630–635.
  20. Cockrell JR, Folstein MF: Mini-Mental State Examination (MMSE). Psychopharmacol Bull1988;24:689–692.
  21. Diniz BS, Yassuda MS, Nunes PV, Radanovic M, Forlenza OV: Mini-Mental State Examination performance in mild cognitive impairment subtypes. Int Psychogeriatr 2007;19:647–656.
  22. Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–2414.
  23. Luboshitzky R, Oberman AS, Kaufman N, Reichman N, Flatau E: Prevalence of cognitive dysfunction and hypothyroidism in an elderly community population. Isr J Med Sci 1996;32:60–65.
  24. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST: Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133–1142.

 goto top of outline Author Contacts

Gregory A. Jicha, MD, PhD
Sanders-Brown Center on Aging, Room 223
800 South Limestone Street
Lexington, KY 40536 (USA)
Tel. +1 859 257 3819, Fax +1 859 257 1412, ext. 255, E-Mail gajich2@email.uky.edu


 goto top of outline Article Information

Accepted: May 23, 2008
Published online: August 23, 2008
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 3, Number of References : 24


 goto top of outline Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 26, No. 2, Year 2008 (Cover Date: September 2008)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420–8008 (Print), eISSN: 1421–9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Objective: Comparative analysis of subjects with mild cognitive impairment (MCI) diagnosed in a primary research setting and those seen in a tertiary care memory disorders clinic. Methods: Subjects who received a diagnosis of MCI between July 1, 2005, and December 31, 2006, in a longitudinal research study of normal cognition (n = 48) and patients diagnosed in a tertiary care referral clinic (n = 34) were evaluated using similar methodologies. Comparative analyses of detailed medical, neurological and neuropsychological data are presented. Results: The diagnosis of MCI was not accepted by 13 of 48 subjects (27%) classified as MCI in the primary research setting. Nondegenerative, potentially treatable causes of cognitive decline were found in 3 of 34 subjects (9%) seen in the tertiary referral clinic and in 11 of 35 subjects (31%) identified as MCI in the primary research setting (p = 0.02, Fisher’s exact test). MCI subjects identified in the primary research setting were older than those referred to the memory clinic (mean ± SD, 79.7 ± 7.0 vs. 71.5 ± 9.0 years, p < 0.0001, t test) and had more years of education (16.0 ± 3.2 vs. 13.6 ± 4.2 years, p < 0.01, t test). MCI subjects in the primary research setting appeared to be in a milder stage of disease, characterized by higher Mini-Mental State Examination scores (28.2 ± 1.8 vs. 25.7 ± 1.8, p < 0.0001), and a tendency towards single domain involvement, predominantly memory (mean number of domains involved, 1.0 vs. 2.5, p < 0.0001). More advanced stages of MCI, seen in the tertiary referral population, had additional involvement of attention (p < 0.0001, Fisher’s exact test) and visuospatial domains (p < 0.0002, Fisher’s exact test). Semiquantitative grading of hippocampal and medial temporal lobe atrophy did not differ between groups (p = 0.81, Mann-Whitney U test). Conclusions: The diagnosis of MCI may be unwelcome in naïve persons. Remedial causes of MCI should be actively investigated. Demographic and clinical characteristics of MCI differ between research subjects and patients referred to a tertiary care clinic.



 goto top of outline Author Contacts

Gregory A. Jicha, MD, PhD
Sanders-Brown Center on Aging, Room 223
800 South Limestone Street
Lexington, KY 40536 (USA)
Tel. +1 859 257 3819, Fax +1 859 257 1412, ext. 255, E-Mail gajich2@email.uky.edu


 goto top of outline Article Information

Accepted: May 23, 2008
Published online: August 23, 2008
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 3, Number of References : 24


 goto top of outline Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 26, No. 2, Year 2008 (Cover Date: September 2008)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420–8008 (Print), eISSN: 1421–9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Bruscoli M, Lovestone S: Is MCI really just early dementia? A systematic review of conversion studies. Int Psychogeriatr 2004;16:129–140.
  2. Busse A, Bischkopf J, Riedel-Heller SG, Angermeyer MC: Subclassifications for mild cognitive impairment: prevalence and predictive validity. Psychol Med 2003;33:1029–1038.
  3. Jicha GA, Petersen RC: Mild cognitive impairment; in Growdon JH, Rossor M (eds): The Dementias 2. Amsterdam, Elsevier, 2007.
  4. Lambon Ralph MA, Patterson K, Graham N, Dawson K, Hodges JR: Homogeneity and heterogeneity in mild cognitive impairment and Alzheimer’s disease: a cross-sectional and longitudinal study of 55 cases. Brain 2003;126:2350–2362.
  5. Lopez OL, Kuller LH, Becker JT, et al: Incidence of dementia in mild cognitive impairment in the cardiovascular health study cognition study. Arch Neurol 2007;64:416–420.
  6. Lopponen M, Raiha I, Isoaho R, Vahlberg T, Kivela SL: Diagnosing cognitive impairment and dementia in primary health care – a more active approach is needed. Age Ageing 2003;32:606–612.
  7. Panza F, Capurso C, D’Introno A, Colacicco AM, Capurso A, Solfrizzi V: Heterogeneity of mild cognitive impairment and other predementia syndromes in progression to dementia. Neurobiol Aging 2007;28:1631–1632, discussion 1633–1634.
  8. Petersen RC: The current status of mild cognitive impairment – what do we tell our patients? Nat Clin Pract Neurol 2007;3:60–61.
  9. Petersen RC: Mild cognitive impairment: current research and clinical implications. Semin Neurol2007;27:22–31.
  10. Portet F, Ousset PJ, Visser PJ, et al: Mild cognitive impairment (MCI) in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consortium on Alzheimer’s Disease. J Neurol Neurosurg Psychiatry 2006;77:714–718.
  11. Stephan BC, Matthews FE, McKeith IG, Bond J, Brayne C: Early cognitive change in the general population: how do different definitions work? J Am Geriatr Soc 2007;55:1534–1540.
  12. Tognoni G, Ceravolo R, Nucciarone B, et al: From mild cognitive impairment to dementia: a prevalence study in a district of Tuscany, Italy. Acta Neurol Scand2005;112:65–71.
  13. Winblad B, Palmer K, Kivipelto M, et al: Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240–246.
  14. Yaffe K, Petersen RC, Lindquist K, Kramer J, Miller B: Subtype of mild cognitive impairment and progression to dementia and death. Dement Geriatr Cogn Disord 2006;22:312–319.
  15. Levitt AJ, Karlinsky H: Folate, vitamin B12 and cognitive impairment in patients with Alzheimer’s disease. Acta Psychiatr Scand 1992;86:301–305.
  16. Schmitt FA, Wetherby MM, Wekstein DR, Dearth CM, Markesbery WR: Brain donation in normal aging: procedures, motivations, and donor characteristics from the Biologically Resilient Adults in Neurological Studies (BRAiNS) Project. Gerontologist 2001;41:716–722.
  17. Knopman DS, DeKosky ST, Cummings JL, et al: Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1143–1153.
  18. Vermersch P, Leys D, Scheltens P, Barkhof F: Visual rating of hippocampal atrophy: correlation with volumetry. J Neurol Neurosurg Psychiatry 1994;57:1015.
  19. Wahlund LO, Julin P, Johansson SE, Scheltens P: Visual rating and volumetry of the medial temporal lobe on magnetic resonance imaging in dementia: a comparative study. J Neurol Neurosurg Psychiatry2000;69:630–635.
  20. Cockrell JR, Folstein MF: Mini-Mental State Examination (MMSE). Psychopharmacol Bull1988;24:689–692.
  21. Diniz BS, Yassuda MS, Nunes PV, Radanovic M, Forlenza OV: Mini-Mental State Examination performance in mild cognitive impairment subtypes. Int Psychogeriatr 2007;19:647–656.
  22. Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–2414.
  23. Luboshitzky R, Oberman AS, Kaufman N, Reichman N, Flatau E: Prevalence of cognitive dysfunction and hypothyroidism in an elderly community population. Isr J Med Sci 1996;32:60–65.
  24. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST: Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133–1142.