title: Prediction of dementia by subjective memory impairment: effects of severity and temporal association with cognitive impairment.
abstract: BACKGROUND
  Subjective memory impairment (SMI) is receiving increasing attention as a pre-mild cognitive impairment (MCI) condition in the course of the clinical manifestation of Alzheimer disease (AD).
  
  
  OBJECTIVE
  To determine the risk for conversion to any dementia, dementia in AD, or vascular dementia by SMI, graded by the level of SMI-related worry and by the temporal association of SMI and subsequent MCI.
  
  
  METHODS
  Longitudinal cohort study with follow-up examinations at 1(1/2) and 3 years after baseline.
  
  
  METHODS
  Primary care medical record registry sample.
  
  
  METHODS
  A total of 2415 subjects without cognitive impairment 75 years or older in the German Study on Aging, Cognition and Dementia in Primary Care Patients.
  
  
  METHODS
  Conversion to any dementia, dementia in AD, or vascular dementia at follow-up 1 or follow-up 2 predicted by SMI with or without worry at baseline and at follow-up 2 predicted by different courses of SMI at baseline and MCI at follow-up 1.
  
  
  RESULTS
  In the first analysis, SMI with worry at baseline was associated with greatest risk for conversion to any dementia (hazard ratio [HR], 3.53; 95% confidence interval [CI], 2.07-6.03) or dementia in AD (6.54; 2.82-15.20) at follow-up 1 or follow-up 2. The sensitivity was 69.0% and the specificity was 74.3% conversion to dementia in AD. In the second analysis, SMI at baseline and MCI at follow-up 1 were associated with greatest risk for conversion to any dementia (odds ratio [OR], 8.92; 95% CI, 3.69-21.60) or dementia in AD (19.33; 5.29-70.81) at follow-up 2. Furthermore, SMI at baseline and amnestic MCI at follow-up 1 increased the risk for conversion to any dementia (OR, 29.24; 95% CI, 8.75-97.78) or dementia in AD (60.28; 12.23-297.10), with a sensitivity of 66.7% and a specificity of 98.3% for conversion to dementia in AD.
  
  
  CONCLUSIONS
  The prediction of dementia in AD by SMI with subsequent amnestic MCI supports the model of a consecutive 3-stage clinical manifestation of AD from SMI via MCI to dementia.
authors.affiliation: Department of Psychiatry, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. Jessen@uni-bonn.de
authors.forename: Frank
authors.initials: F
authors.lastname: Jessen
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.forename: Cadja
authors.initials: C
authors.lastname: Bachmann
authors.forename: Sandra
authors.initials: S
authors.lastname: Eifflaender-Gorfer
authors.forename: Franziska
authors.initials: F
authors.lastname: Haller
authors.forename: Heike
authors.initials: H
authors.lastname: Kölsch
authors.forename: Tobias
authors.initials: T
authors.lastname: Luck
authors.forename: Edelgard
authors.initials: E
authors.lastname: Mösch
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.forename: Anja
authors.initials: A
authors.lastname: Wollny
authors.forename: Thomas
authors.initials: T
authors.lastname: Zimmermann
authors.forename: Michael
authors.initials: M
authors.lastname: Pentzek
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Romberg
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.forename: Hanna
authors.initials: H
authors.lastname: Kaduszkiewicz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis / Q000523:psychology*; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors