title: Memory concerns, memory performance and risk of dementia in patients with mild cognitive impairment.
abstract: BACKGROUND
  Concerns about worsening memory ("memory concerns"; MC) and impairment in memory performance are both predictors of Alzheimer's dementia (AD). The relationship of both in dementia prediction at the pre-dementia disease stage, however, is not well explored. Refined understanding of the contribution of both MC and memory performance in dementia prediction is crucial for defining at-risk populations. We examined the risk of incident AD by MC and memory performance in patients with mild cognitive impairment (MCI).
  
  
  METHODS
  We analyzed data of 417 MCI patients from a longitudinal multicenter observational study. Patients were classified based on presence (n = 305) vs. absence (n = 112) of MC. Risk of incident AD was estimated with Cox Proportional-Hazards regression models.
  
  
  RESULTS
  Risk of incident AD was increased by MC (HR = 2.55, 95%CI: 1.33-4.89), lower memory performance (HR = 0.63, 95%CI: 0.56-0.71) and ApoE4-genotype (HR = 1.89, 95%CI: 1.18-3.02). An interaction effect between MC and memory performance was observed. The predictive power of MC was greatest for patients with very mild memory impairment and decreased with increasing memory impairment.
  
  
  CONCLUSIONS
  Our data suggest that the power of MC as a predictor of future dementia at the MCI stage varies with the patients' level of cognitive impairment. While MC are predictive at early stage MCI, their predictive value at more advanced stages of MCI is reduced. This suggests that loss of insight related to AD may occur at the late stage of MCI.
authors.affiliation: Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases, Bonn, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Wolfsgruber
authors.affiliation: Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases, Bonn, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Center for Geriatric Medicine, Ortenau Klinikum, Offenburg-Gengenbach, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Schmidtke
authors.affiliation: Department of Gerontopsychiatry, Central Institute of Mental Health, Mannheim, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Frölich
authors.affiliation: Department of Psychiatry, Technical University of Munich, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kurz
authors.affiliation: Department of Neurology, University of Aachen, Aachen, Germany; Department of Psychiatry, University of Göttingen, Göttingen, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulz
authors.affiliation: Department of Psychiatry, Ludwig Maximilian University, Munich, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Hampel
authors.affiliation: Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Isabella
authors.initials: I
authors.lastname: Heuser
authors.affiliation: Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Peters
authors.affiliation: Department of Psychiatry, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Friedel M
authors.initials: FM
authors.lastname: Reischies
authors.affiliation: Department of Psychiatry, University of Hamburg, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Jahn
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Luckhaus
authors.affiliation: Center for Geriatric Medicine and Gerontology, University of Freiburg, Freiburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hüll
authors.affiliation: Department of Psychiatry, University of Leipzig, Leipzig, Germany.
authors.forename: Hermann-Josef
authors.initials: HJ
authors.lastname: Gertz
authors.affiliation: Department of Psychiatry, University of Heidelberg, Heidelberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schröder
authors.affiliation: Institute of General Practice, University of Frankfurt, Frankfurt am Main, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Pantel
authors.affiliation: Department of Medical Informatics, University of Göttingen, Göttingen, Germany.
authors.forename: Otto
authors.initials: O
authors.lastname: Rienhoff
authors.affiliation: Department of Psychiatry, University of Göttingen, Göttingen, Germany.
authors.forename: Eckart
authors.initials: E
authors.lastname: Rüther
authors.affiliation: Brookhaven National Laboratory, Upton, New York, United States of America.
authors.forename: Fritz
authors.initials: F
authors.lastname: Henn
authors.affiliation: Department of Psychiatry University of Essen, Essen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Wiltfang
authors.affiliation: Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Psychiatry, Friedrich-Alexander-University Erlangen, Erlangen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kornhuber
authors.affiliation: Department of Psychiatry, University of Bonn, Bonn, Germany; German Center for Neurodegenerative Diseases, Bonn, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Jessen
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000235:genetics; D053327:Apolipoprotein E4 / Q000235:genetics; D060825:Cognitive Dysfunction / Q000523:psychology*; D005260:Female; D005838:Genotype; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008568:Memory; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk
chemical_list: D053327:Apolipoprotein E4