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American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2006 Jun-Jul;21(3):189–196. doi: 10.1177/1533317506289348

Neuropsychological Markers of Progression From Mild Cognitive Impairment to Alzheimer’s Disease

Alberto Marcos 1, Pedro Gil 2, Ana Barabash 3, Raquel Rodriguez 4, Marta Encinas 5, Cristina Fernández 6, José Antonio Cabranes 7
PMCID: PMC10833278  PMID: 16869340

Abstract

To find early clinical markers that may predict a likely progression to Alzheimer’s disease (AD), the authors performed neuropsychological tests on 82 mild cognitive impairment (MCI) subjects. After 3 years, 38 patients developed AD while 44 retained the diagnosis of MCI. The cognitive differences between the groups were studied. Patients who developed AD showed significantly lower values than did MCI subjects in some neuropsychological scores (P = .02-.001), with sensitivities and specificities higher than 84% and 64%, respectively, for detecting early-onset AD, with a 7.9-fold increased risk of converting to AD (P < .001). Regarding the logistic regression model, the CAMCOG Memory and Perception cognitive screening items were the optimum independent tools to classify the patients who will progress to AD, showing a relative risk of progression of 10.5 (P = .002), 5.5 (P = .008), and 3.9 times (P = .05), respectively, with a sensibility of of 92.1% and a specificity 72.7%.

Keywords: mild cognitive impairment, Alzheimer’s disease, neuropsychological test, preclinical markers

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Contributor Information

Alberto Marcos, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain, a_marcos_d@yahoo.es .

Pedro Gil, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.

Ana Barabash, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.

Raquel Rodriguez, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.

Marta Encinas, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.

Cristina Fernández, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.

José Antonio Cabranes, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain.

References

  1. Petersen RC, Stevens JC, Gangly M, et al. 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. [DOI] [PubMed] [Google Scholar]
  2. Petersen RC, Dowdy R, Kurtz A, et al. Current concepts in mild cognitive impairment. Arch Neurol. 2001;58: 1985-1992. [DOI] [PubMed] [Google Scholar]
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC, American Psychiatric Association; 1994. [Google Scholar]
  4. World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders. Geneva, Switzerland: World Health Organization; 1992. [Google Scholar]
  5. Robles A, Del Ser T, Alum J, et al. Prophets de criterions Para el diagnóstico clínico del deteriorate cognitive liger, la dementia y la enfermedad de Alzheimer. Neurología. 2002;17(1):17-32. [PubMed] [Google Scholar]
  6. Ritchie K, Artero S, Touchon J. Classification criteria for mild cognitive impairment: a population-based validation study. Neurology. 2001;56:37-42. [DOI] [PubMed] [Google Scholar]
  7. Amieva H, Letenneur L, Dartigues JF, et al. Annual rate and predictors of conversion to dementia in subjects presenting mild cognitive impairment criteria defined according to a population-based study. Dement Geriatr Cogn Disord. 2004;18:87-93. [DOI] [PubMed] [Google Scholar]
  8. Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56:303-308. [DOI] [PubMed] [Google Scholar]
  9. Bennett DA, Wilson RS, Schneider JA, et al. Natural history of mild cognitive impairment in older persons. Neurology. 2002;59:198-205. [DOI] [PubMed] [Google Scholar]
  10. Schofield PW, Marder K, Doonieief G, et al. Association of subjective memory complaints with subsequent cognitive decline in community-dwelling elderly individuals with baseline cognitive impairment. Am J Psychiatry. 1997;154: 609-615. [DOI] [PubMed] [Google Scholar]
  11. Johansson B, Zarit SH. Early cognitive markers of the incidence of dementia and mortality: a longitudinal study of the oldest old. Int J Geriatr Psychiatry. 1997;12:53-59. [DOI] [PubMed] [Google Scholar]
  12. Ritchie K, Ledesert B, Touchon J. Subclinical cognitive impairment: epidemiology and clinical characteristics. Compr Psychiatry. 2000;41:61-65. [DOI] [PubMed] [Google Scholar]
  13. Hogan DB, Ebly EM. Predicting who will develop dementia in a cohort of Canadian seniors. Can J Neurol Sci. 2000;27: 18-24. [DOI] [PubMed] [Google Scholar]
  14. Tierney MC, Szalai JP, Snow WG, et al. Prediction of probable Alzheimer’s disease in memory-impaired patients: a prospective longitudinal study. Neurology. 1996;46:661-665. [DOI] [PubMed] [Google Scholar]
  15. Morris JC, Storandt M, Phillip JP, et al. Mild cognitive impairment represents early-stage Alzheimer’s disease. Arch Neurol. 2001;58:397-405. [DOI] [PubMed] [Google Scholar]
  16. Bozoki A, Giordani B, Heidebrink JL, et al. Mild cognitive impairment predicts dementia in non-demented elderly patients with memory loss. Arch Neurol. 2001;58:411-416. [DOI] [PubMed] [Google Scholar]
  17. Christiansen H, Henderson AS, Korten AE, et al. ICD- 10 mild cognitive disorder: its outcome three years later. Int Geriatr Psychiatry. 1997;12:581-586. [DOI] [PubMed] [Google Scholar]
  18. Daly E, Zaithchik D, Copeland M, et al. Predicting conversion to Alzheimer’s disease using standardized clinical information. Arch Neurol. 2000;57:675-680. [DOI] [PubMed] [Google Scholar]
  19. Palmer K, Wang H, Backman L, et al. Differential evolution of cognitive impairment in non-demented older persons: results from the Kungsholmen Project. Am J Psychiatry. 2002;59:436-442. [DOI] [PubMed] [Google Scholar]
  20. Tian J, Bucks RS, Haworth J, et al. Neuropsychological prediction of conversion to dementia from questionable dementia: statistically significant but not yet clinically useful. J Neurol Neurosurg Psychiatry. 2003;74:413-414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Karlawish JH, Clark CM. Diagnostic evaluation of elderly patients with mild memory problems. Ann Intern Med. 2003; 138(5):411-419. [DOI] [PubMed] [Google Scholar]
  22. Wolf H, Jelic V, Gertz HJ, et al. A critical discussion of the role of neuroimaging in mild cognitive impairment. Acta Neurol Scand. 2003;179(suppl):52-76. [DOI] [PubMed] [Google Scholar]
  23. Rubin EH, Morris JC, Grant EA, et al. Very mild senile dementia of the Alzheimer type-I: clinical assessment. Arch Neurol. 1989;46:379-382. [DOI] [PubMed] [Google Scholar]
  24. Masur DM, Sliwinski M, Lipton RB, et al. Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons. Neurology. 1994;44:1427-1432. [DOI] [PubMed] [Google Scholar]
  25. Howieson DB, Dame A, Camicioli R, et al. Cognitive markers preceding Alzheimer’s dementia in the healthy oldest old. J Am Geriatr Soc. 1997;45:584-589. [DOI] [PubMed] [Google Scholar]
  26. Wolf H, Grunwald M, Ecke GM, et al. The prognosis of mild cognitive impairment in the elderly. J Neural Transm Suppl. 1998;54:31-50. [DOI] [PubMed] [Google Scholar]
  27. Camicioli R, Howieson D, Oken B, et al. Motor slowing precedes cognitive impairment in the oldest old. Neurology. 1998;50:1496-1498. [DOI] [PubMed] [Google Scholar]
  28. Maccioni RB, Lavados M, Maccioni CB, et al. Biological markers of Alzheimer’s disease and mild cognitive impairment. Curr Alzheimer Res. 2004;1: 307-314. [DOI] [PubMed] [Google Scholar]
  29. Vanderstichele H, De Meyer G, Andreasen N, et al. Amino-truncated β-amyloid-42 peptides in cerebrospinal fluid and prediction of progression of mild cognitive impairment. Clin Chem. 2005;51:1650-1660. [DOI] [PubMed] [Google Scholar]
  30. Van Dujin CM. Prospects of genetic research of mild cognitive impairment. J Intern Med. 2004;256:235-239. [DOI] [PubMed] [Google Scholar]
  31. Meneses A: 5-HT system and cognition. Neurosci Biobehav Rev. 1999;23:1111-1125. [DOI] [PubMed] [Google Scholar]
  32. Bigler ED, Lowry CM, Anderson CV, et al. Dementia, quantitative neuroimaging, and apolipoprotein E genotype. Am J Neuroradiol. 2000;211:857-868. [PMC free article] [PubMed] [Google Scholar]
  33. De Leon MJ, George AE, Golomb J, et al. Frequency of hippocampal-formation atrophy in normal aging and Alzheimer’s disease. Neurobiol Aging. 1997;18:1-11. [DOI] [PubMed] [Google Scholar]
  34. Jack CR Jr, Petersen RC, Xu YC, et al. Prediction of AD with MRI-based hippocampal volume in mild cognitive impairment. Neurology. 1999;52:1397-1403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Jack CR Jr, Petersen RC, Xu YC, et al. Rates of hippocampal atrophy correlate with change in clinical status in aging and AD. Neurology. 2000;55:484-489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Yamaguchi S, Menguro K, Shimada M, et al. Five-year retrospective changes in hippocampal atrophy and cognitive-screening-test performances in very mild Alzheimer’s disease: the Tajiri Project. Neuroradiology. 2002;44:43-48. [DOI] [PubMed] [Google Scholar]
  37. Du AT, Schuff N, Amend D, et al. Magnetic resonance imaging of the entorhinal cortex and hippocampus in mild cognitive impairment and Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2001;71:441-447. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Kantarci K, Xu YC, Shiung MM, et al. Comparative diagnostic utility of different MR modalities in mild cognitive impairment and Alzheimer’s disease. Dement Geriatr Cogn Disord. 2002;14:198-207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Kantarci K, Jack CR Jr. Neuroimaging in Alzheimer’s disease: an evidence-based review. Neuroimaging Clin N Am. 2003;13:197-209. [DOI] [PubMed] [Google Scholar]
  40. Kantarci K, Jack CR Jr, Xu YC, et al. Regional metabolic patterns in mild cognitive impairment and Alzheimer’s disease: a 1H MRS study. Neurology. 2000;55:210-217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Parnetti L, Lowenthal D, Presciutti O, et al. H-MRS, MRI-based hippocampal volumetry, and 99mTc-HMPAO-SPET in normal aging, age-associated memory impairment, and probable Alzheimer’s disease. J Am Geriatr Soc. 1996;44:209-211. [DOI] [PubMed] [Google Scholar]
  42. De Santi S, de Leon MJ, Rusinek H, et al. Hippocampal formation, glucose metabolism, and volume losses in MCI and AD. Neurobiol Aging. 2001;22:529-539. [DOI] [PubMed] [Google Scholar]
  43. De Leon MJ, Convit A, Wolf OT, et al. Prediction of cognitive decline in normal elderly subjects with 2-(18F)fluoro- 2-deoxi-D-glucose/positron-emission tomography (FDG/PET). Proc Natl Acad Sci U S A. 2001;98:10966-10971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Arnaiz E, Jelic V, Almkvist O, et al. Impaired cerebral glucose metabolism and cognitive functioning predict deterioration in mild cognitive impairment. Neuroreport. 2001;12: 851-855. [DOI] [PubMed] [Google Scholar]
  45. Kogure D, Matsuda H, Ohnishi T, et al. Longitudinal evaluation of early Alzheimer’s disease using brain per-fusion SPECT. J Nucl Med. 2000;41:1155-1562. [PubMed] [Google Scholar]
  46. Okamura N, Shinkawa M, Arai H, et al. Prediction of progression in patients with mild cognitive impairment using IMP-SPECT. Nippon Ronen Igakkai Zasshi. 2000;37:974-978. [DOI] [PubMed] [Google Scholar]
  47. Ishiwatta A, Kitamura S, Nagazumi A, et al. Cerebral blood flow of patients with age-associated memory impairment and the early stage of Alzheimer’s disease: a study by SPECT using the ARG method. Nippon Ika Daigaku Zasshi. 1998; 65:140-147. [DOI] [PubMed] [Google Scholar]
  48. Johson KA, Jones K, Holman BL, et al. Preclinical prediction of Alzheimer’s disease using SPECT. Neurology. 1998;50: 1563-1572. [DOI] [PubMed] [Google Scholar]
  49. Chételat G, Desgranges B, de la Sayette V, et al. Mild cognitive impairment: can FDG-PET predict who is to rapidly convert to Alzheimer’s disease? Neurology. 2003;60: 1374-1377. [DOI] [PubMed] [Google Scholar]
  50. Marquis S, Moore M, Howieson DB, et al. Independent predictors of cognitive decline in healthy elderly persons. Arch Neurol. 2002;59:601-606. [DOI] [PubMed] [Google Scholar]
  51. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198. [DOI] [PubMed] [Google Scholar]
  52. Petersen RC, Smith GE, Waring SC, et al. Aging memory and mild cognitive impairment. Int Psychogeriatr. 1997;9: 65-69. [DOI] [PubMed] [Google Scholar]
  53. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Practice parameters for diagnosis and evaluation of dementia (summary statement). Neurology. 1994;44:2203-2206. [DOI] [PubMed] [Google Scholar]
  54. Busse A, Bischkopf J, Riedel-Heller SG, et al. Mild cognitive impairment: prevalence and incidence according to different diagnostic criteria—results of the Leipzig Longitudinal Study of the Aged (LEILA75+). Br J Psychiatry. 2003;182: 449-454. [PubMed] [Google Scholar]
  55. Storand M, Grant EA, Miller JP, et al. Rates of progression in mild cognitive impairment and early Alzheimer’s disease. Neurology. 2002;59:1034-1041. [DOI] [PubMed] [Google Scholar]
  56. Petersen RC, Morris JC. Mild cognitive impairment as a clinical entity and treatment target. Arch Neurol. 2005;62:1160-1163. [DOI] [PubMed] [Google Scholar]
  57. Gauthier S, Touchon J. Mild cognitive impairment is not a clinical entity and should not be treated. Arch Neurol. 2005; 62:1164-1166. [DOI] [PubMed] [Google Scholar]
  58. Knopman DS, Boeve BF, Petersen RC. Essentials of proper diagnosis of mild cognitive impairment, dementia, and major subtypes of dementia. Mayo Clin Proc. 2003;78:1290-1308. [DOI] [PubMed] [Google Scholar]
  59. Tuokko H, Frerichs R, Graham J, et al. Five-year follow-up of cognitive impairment with no dementia. Arch Neurol. 2003;60:577-582. [DOI] [PubMed] [Google Scholar]
  60. Collie A, Maruff P, Shafiq-Antonacci R, et al. Memory decline in healthy older people: implications for identifying mild cognitive impairment. Neurology. 2001;56: 1533-1538. [DOI] [PubMed] [Google Scholar]
  61. Luis CA, Barker W, Loewenstein DA, et al. Conversion to dementia among two groups with cognitive impairment. Dement Geriatr Cogn Disord. 2004;18:307-313. [DOI] [PubMed] [Google Scholar]
  62. Visser PJ, Verhey FR, Scheltens P, et al. Diagnostic accuracy of the pre-clinical AD scale (PAS) in cognitively mildly impaired subjects. J Neurol. 2002;249: 312-319. [DOI] [PubMed] [Google Scholar]
  63. Visser PJ, Verhey FR, Ponds RW, et al. Diagnosis of pre-clinical Alzheimer’s disease in a clinical setting. Int Psychogeriatr. 2001;13:411-423. [DOI] [PubMed] [Google Scholar]
  64. Perry RJ, Watson P, Hodges JR. The nature and staging of attention dysfunction in early (minimal and mild) Alzheimer’s disease: relationship to episodic and semantic memory impairment. Neuropsychologia. 2000;38:252-271. [DOI] [PubMed] [Google Scholar]
  65. Arnaiz E, Almkvist O. Neuropsychological features of mild cognitive impairment and pre-clinical Alzheimer’s disease. Acta Neurol Scand. 2003;179(suppl):34-41. [PubMed] [Google Scholar]
  66. Cullum C, Huppert FA, McGee M, et al. Decline across different domains of cognitive functioning in normal aging: results of a longitudinal population-based study using CAMCOG. Int Geriatr Psychiatry. 2000;15:853-862. [DOI] [PubMed] [Google Scholar]
  67. De Jager CA, Hogervorst E, Combrinck M, et al. Sensitivity and specificity of neuropsychological tests for mild cognitive impairment, vascular cognitive impairment, and Alzheimer’s disease. Psychol Med. 2003;33: 1039-1050. [DOI] [PubMed] [Google Scholar]
  68. Ready RE, Ott BR, Grace J, et al. Apathy and executive dysfunction in mild cognitive impairment and Alzheimer’s disease. Am J Geriatr Psychiatry. 2003;11:222-228. [PubMed] [Google Scholar]
  69. Boyle PA, Malloy PF, Salloway S, et al. Executive dysfunction and apathy predict functional impairment in Alzheimer’s disease. Am J Geriatr Psychiatry. 2003;11: 214-221. [PubMed] [Google Scholar]
  70. Grundman M, Jack CR, Petersen RC, et al. Hippocampal volume is associated with memory, but not non-memory, cognitive performance in patients with mild cognitive impairment. J Mol Neurosci. 2003;20:241-248. [DOI] [PubMed] [Google Scholar]
  71. Chételat G, Desgranges B, de la Sayette V, et al. Dissociating atrophy and hypometabolism impact on episodic memory in mild cognitive impairment. Brain. 2003;126:1955-1967. [DOI] [PubMed] [Google Scholar]
  72. Lambon Ralph MA, Patterson K, Graham N, et al. 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. [DOI] [PubMed] [Google Scholar]
  73. Ingles JL, Fisk JD, Merry HR, et al. Five-year outcomes for dementia defined solely by neuropsychological-test performance. Neuroepidemiology. 2003;22:172-178. [DOI] [PubMed] [Google Scholar]

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