Risk factors for mild cognitive impairment in the Cardiovascular Health Study Cognition Study: part 2.
OBJECTIVE
To examine the risk factors for mild cognitive impairment (MCI) in a longitudinal population study-the Cardiovascular Health Study Cognition Study.


METHODS
We examined the factors that in the period 1991 through 1994 predicted the development of MCI in all participants of the Cardiovascular Health Study Cognition Study. Further examination was conducted in the Pittsburgh, Pa, cohort (n = 927), where participants with MCI were classified as having either the MCI amnestic-type or the MCI multiple cognitive deficits-type.


METHODS
Multicenter population study.


METHODS
This study includes all participants of the Cardiovascular Health Study Cognition Study (n = 3608) who had a magnetic resonance imaging (MRI) scan of the brain between 1991 and 1994, and detailed neuropsychological, neurological, and medical evaluations to identify the presence of MCI or dementia in the period 1998 to 1999. The mean time between the closest clinical examination to the MRI and the diagnostic evaluation for cognitive disorders was 5.8 years for the Cardiovascular Health Study Cognition Study cohort and 6.0 years for the Pittsburgh cohort.


METHODS
Risk factors for MCI at the time of the MRI were identified using logistic regression, controlling for age, race, educational level, baseline Modified Mini-Mental State Examination and Digit Symbol Test scores, measurements of depression, MRI findings (atrophy, ventricular volume, white matter lesions, and infarcts), the presence of the apolipoprotein E (APOE) epsilon4 allele, hypertension, diabetes mellitus, and heart disease.


RESULTS
Mild cognitive impairment (n = 577) was associated with race (African American), low educational level, low Modified Mini-Mental State Examination and Digit Symbol Test scores, cortical atrophy, MRI-identified infarcts, and measurements of depression. The MCI amnestic-type was associated with MRI-identified infarcts, the presence of the APOE epsilon4 allele, and low Modified Mini-Mental State Examination scores. The MCI multiple cognitive deficits-type was associated with low Modified Mini-Mental State Examination and Digit Symbol Test scores.


CONCLUSIONS
The development of MCI is associated with measurements of cognition and depression, racial and constitutional factors, and cerebrovascular disease. Early cognitive deficits seem to be a common denominator for the 2 forms of MCI; the presence of cerebrovascular disease and the APOE epsilon4 allele is associated with the amnestic type of MCI.
Departments of Neurology and Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pa, USA. lopezol@msx.upmc.edu
Oscar L
OL
Lopez
William J
WJ
Jagust
Corinne
C
Dulberg
James T
JT
Becker
Steven T
ST
DeKosky
Annette
A
Fitzpatrick
John
J
Breitner
Constantine
C
Lyketsos
Beverly
B
Jones
Claudia
C
Kawas
Michelle
M
Carlson
Lewis H
LH
Kuller
D000368:Aged; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000235:genetics; D001921:Brain / Q000473:pathology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology*; D003072:Cognition Disorders / Q000453:epidemiology* / Q000235:genetics / Q000523:psychology*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D011153:Population; D012307:Risk Factors
D053327:Apolipoprotein E4; D001057:Apolipoproteins E