Qualitative estimates of medial temporal atrophy as a predictor of progression from mild cognitive impairment to dementia.
BACKGROUND
Individuals diagnosed as having mild cognitive impairment (MCI) have a high likelihood of progressing to dementia within 3 to 5 years, but not all individuals with MCI progress to dementia. Prognostic uncertainty suggests the need for additional measures to assist the clinician.


OBJECTIVE
To assess the added value of qualitative measures of medial temporal atrophy (MTA) to estimate the relative risk of progressing from MCI to dementia.


METHODS
A 3-year, double-blind, placebo-controlled Alzheimer's Disease Cooperative Study initially designed to evaluate the efficacy of donepezil hydrochloride or vitamin E vs placebo to delay progression of MCI to dementia.


METHODS
Memory assessment centers.


METHODS
A total of 190 individuals with MCI.


METHODS
Ratings of MTA performed using magnetic resonance images obtained at baseline. Log-rank tests and Cox proportional hazards ratios examining the significance of MTA estimates in predicting progression of MCI to dementia.


RESULTS
A mean MTA score greater than 2.0 was associated with a greater than 2-fold increased likelihood of progression to dementia during the observation period (hazards ratio, 2.30; 95% confidence interval, 1.09-4.92; P = .03) after controlling for age, education, sex, and baseline Mini-Mental State Examination score.


CONCLUSIONS
Adjusted estimates of MTA were associated with significantly increased risk of developing dementia within 3 years, suggesting that obtaining a magnetic resonance image during the evaluation of MCI may offer additional independent information about the risk of progression to dementia. Given the relatively high prevalence of MCI in the general population, use of this method as part of routine clinical evaluation may help identify individuals who might benefit from increased surveillance and future treatment.


BACKGROUND
clinicaltrials.gov Identifier: NCT00000173.
DeCarli
Charles
C
Department of Neurology and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California at Davis, Sacramento 95817, USA. cdecarli@ucdavis.edu
Frisoni
Giovanni B
GB
Clark
Christopher M
CM
Harvey
Danielle
D
Grundman
Michael
M
Petersen
Ronald C
RC
Thal
Leon J
LJ
Jin
Shelia
S
Jack
Clifford R
CR
Scheltens
Philip
P
D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000473:pathology / Q000517:prevention & control; D003072:Cognition Disorders / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D003704:Dementia / Q000209:etiology* / Q000473:pathology* / Q000517:prevention & control; D018450:Disease Progression; D000077265:Donepezil; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013702:Temporal Lobe / Q000187:drug effects / Q000473:pathology*; D014810:Vitamin E / Q000008:administration & dosage
D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D014810:Vitamin E; D000077265:Donepezil