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Optimizing Mild Cognitive Impairment for Discriminating Dementia Risk in the General Older Population

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)

Publication metadata

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


DOI: 10.1097/JGP.0b013e3181e0450d


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Funder referenceFunder name
ERA-Age Future Leaders of Ageing (FLARE)
Department of Health
U.1052.00.013Medical Research Council (MRC)