title: White matter disease independently predicts progression from mild cognitive impairment to Alzheimer's disease in a clinic cohort.
abstract: BACKGROUND
  The contribution of vascular pathology to the rate of progression from mild cognitive impairment (MCI) to Alzheimer's disease (AD) remains unclear.
  
  
  OBJECTIVE
  To ascertain the relative roles of cerebral white matter disease and medial temporal atrophy (MTA) in predicting progression from MCI to AD.
  
  
  METHODS
  MCI patients with baseline MRI and ≥18 months of longitudinal follow-up were evaluated. DSM-IV-TR criteria were used to diagnose conversion to dementia. MTA and white matter hyperintensity (WMH) were quantified using the Scheltens scale and modified Fazekas scale.
  
  
  RESULTS
  Of a total of 171 MCI patients, 79 patients with baseline MRI and longitudinal follow-up were studied. Twenty-three MCI patients who progressed to dementia (MCI-P) were identified corresponding to a 19.4% annual risk of conversion. In MCI-P patients, the mean Mini-Mental State Examination and Montreal Cognitive Assessment decline was 1.3 and 2.9 points, respectively. MTA, periventricular WMH and deep subcortical WMH were significantly greater in the MCI-P cohort. WMH was found to predict MCI-P with an odds ratio of 7.69 (p = 0.03).
  
  
  CONCLUSIONS
  MTA and deep subcortical WMH independently predict conversion from MCI to AD. Optimization of vascular risk factors among patients with MCI can potentially reduce the conversion from MCI to AD.
authors.affiliation: Department of Neurology, National Neuroscience Institute, 11 Jalan Tock Seng, Singapore.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Prasad
authors.forename: Lynn
authors.initials: L
authors.lastname: Wiryasaputra
authors.forename: Amanda
authors.initials: A
authors.lastname: Ng
authors.forename: Nagaendran
authors.initials: N
authors.lastname: Kandiah
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000473:pathology* / Q000523:psychology*; D001921:Brain / Q000473:pathology*; D060825:Cognitive Dysfunction / Q000473:pathology* / Q000523:psychology*; D015331:Cohort Studies; D016208:Databases, Factual; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000473:pathology* / Q000523:psychology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors