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Lookup NU author(s): Professor Bloss Stephan, Professor Carol Brayne, Professor John Bond, Professor Ian McKeith
Background: Criteria for mild cognitive impairment (MCI) predict dementia risk in the clinic. Dementia risk in the population is different and whether there is an optimal MCI-derived threshold for discriminating at-risk from not-at-risk cases in the general older population is not known. Methods: Data were from the Medical Research Council Cognitive Function and Ageing Study. Two risk thresholds were derived from each of seven different concepts of MCI including: Mayo Clinic-defined amnestic, nonamnestic, multiple, and revised MCI, MCI based on Mini-Mental State Examination derived categories, and the definitions of Cognitive Impairment No Dementia and Age-Related Cognitive Decline ( ARCD). Receiver operating characteristic analysis was used to compare the predictive validity of 2-year incident dementia for each risk threshold across the different MCI definitions. Findings: MCI-derived risk thresholds varied in their ability to predict dementia. MCI thresholds were accurate in identifying individuals not at-risk of dementia progression (false-negative range: 0%-3.4%). No MCI-derived threshold accurately identified an at-risk group with a 2-year progression rate greater than 20%. Criteria for ARCD defined the threshold with the highest sensitivity and specificity for dementia conversion. Interpretation: MCI-derived thresholds do not reliably identify individuals at-risk of incident dementia at 2 years when applied in the general population. A large subpopulation of individuals not at-risk was more reliably identified. What is considered a sufficient level of accuracy for identification of individuals at increased risk of dementia depends on the motivation for screening and on the safety and efficacy of available interventions. (Am J Geriatr Psychiatry 2010; 18: 662-673)
Author(s): Stephan BCM, Savva GM, Brayne C, Bond J, McKeith IG, Matthews FE, Med Res Council Cognitive Function
Publication type: Article
Publication status: Published
Journal: American Journal of Geriatric Psychiatry
Year: 2010
Volume: 18
Issue: 8
Pages: 662-673
Print publication date: 01/08/2010
Date deposited: 09/11/2010
ISSN (print): 1064-7481
ISSN (electronic): 1545-7214
Publisher: Lippincott Williams & Wilkins
URL: http://dx.doi.org/10.1097/JGP.0b013e3181e0450d
DOI: 10.1097/JGP.0b013e3181e0450d
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