title: Prognosis of mild cognitive impairment in general practice: results of the German AgeCoDe study.
abstract: OBJECTIVE
  The concept of mild cognitive impairment (MCI) has recently been introduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as mild neurocognitive disorder, making it a formal diagnosis. We investigated the prognostic value of such a diagnosis and analyzed the determinants of the future course of MCI in the AgeCoDe study (German Study on Ageing, Cognition, and Dementia in Primary Care Patients).
  
  
  METHODS
  We recruited 357 patients with MCI aged 75 years or older from primary care practices and conducted follow-up with interviews for 3 years. Depending on the course of impairment over time, the patients were retrospectively split into 4 groups representing remittent, fluctuating, stable, and progressive courses of MCI. We performed ordinal logistic regression analysis and classification and regression tree (CART) analysis.
  
  
  RESULTS
  Overall, 41.5% of the patients had remission of symptoms with normal cognitive function 1.5 and 3 years later, 21.3% showed a fluctuating course, 14.8% had stable symptoms, and 22.4% had progression to dementia. Patients were at higher risk for advancing from one course to the next along this spectrum if they had symptoms of depression, impairment in more than 1 cognitive domain, or more severe cognitive impairment, or were older. The result on a test of the ability to learn and reproduce new material 10 minutes later was the best indicator at baseline for differentiating between remittent and progressive MCI. Symptoms of depression modified the prognosis.
  
  
  CONCLUSIONS
  In primary care, about one-quarter of patients with MCI have progression to dementia within the next 3 years. Assessments of memory function and depressive symptoms are helpful in predicting a progressive vs a remittent course. When transferring the concept of MCI into clinical diagnostic algorithms (eg, DSM-5), however, we should not forget that three-quarters of patients with MCI stayed cognitively stable or even improved within 3 years. They should not be alarmed unnecessarily by receiving such a diagnosis.
authors.affiliation: Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany (Kaduszkiewicz, Eisele, van den Bussche, Scherer); Hannover Medical School, Hannover, Germany (Wiese, Prokein); Institute of Primary Medical Care, University Medical Center Schleswig-Holstein (Kaduszkiewicz); Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany (Luppa, Luck, Riedel-Heller); Department of Psychiatry, University of Bonn, Germany (Jessen, Maier); Department of Psychiatry, Technical University of Munich, Germany (Bickel, Mösch); Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany (Pentzek, Fuchs); Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany (Eifflaender-Gorfer, Weyerer); Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Germany (König, Brettschneider); German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (Maier, Jessen).
authors.forename: Hanna
authors.initials: H
authors.lastname: Kaduszkiewicz
authors.forename: Marion
authors.initials: M
authors.lastname: Eisele
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.forename: Jana
authors.initials: J
authors.lastname: Prokein
authors.forename: Melanie
authors.initials: M
authors.lastname: Luppa
authors.forename: Tobias
authors.initials: T
authors.lastname: Luck
authors.forename: Frank
authors.initials: F
authors.lastname: Jessen
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.forename: Edelgard
authors.initials: E
authors.lastname: Mösch
authors.forename: Michael
authors.initials: M
authors.lastname: Pentzek
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.forename: Sandra
authors.initials: S
authors.lastname: Eifflaender-Gorfer
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.forename: Christian
authors.initials: C
authors.lastname: Brettschneider
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D058006:General Practice; D015577:Geriatric Assessment; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
keywords: Alzheimer disease; dementia; disease course; mild cognitive impairment; practice-based research; primary care; prognosis