title: A clinical index to predict progression from mild cognitive impairment to dementia due to Alzheimer's disease.
abstract: BACKGROUND
  Mild cognitive impairment is often a precursor to dementia due to Alzheimer's disease, but many patients with mild cognitive impairment never develop dementia. New diagnostic criteria may lead to more patients receiving a diagnosis of mild cognitive impairment.
  
  
  OBJECTIVE
  To develop a prediction index for the 3-year risk of progression from mild cognitive impairment to dementia relying only on information that can be readily obtained in most clinical settings.
  
  
  METHODS
  382 participants diagnosed with amnestic mild cognitive impairment enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI), a multi-site, longitudinal, observational study.
  Demographics, comorbid conditions, caregiver report of participant symptoms and function, and participant performance on individual items from basic neuropsychological scales.
  
  
  METHODS
  Progression to probable Alzheimer's disease.
  
  
  RESULTS
  Subjects had a mean (SD) age of 75 (7) years and 43% progressed to probable Alzheimer's disease within 3 years. Important independent predictors of progression included being female, resisting help, becoming upset when separated from caregiver, difficulty shopping alone, forgetting appointments, number of words recalled from a 10-word list, orientation and difficulty drawing a clock. The final point score could range from 0 to 16 (mean [SD]: 4.2 [2.9]). The optimism-corrected Harrell's c-statistic was 0.71(95% CI: 0.68-0.75). Fourteen percent of subjects with low risk scores (0-2 points, n = 124) converted to probable Alzheimer's disease over 3 years, compared to 51% of those with moderate risk scores (3-8 points, n = 223) and 91% of those with high risk scores (9-16 points, n = 35).
  
  
  CONCLUSIONS
  An index using factors that can be obtained in most clinical settings can predict progression from amnestic mild cognitive impairment to probable Alzheimer's disease and may help clinicians differentiate between mild cognitive impairment patients at low vs. high risk of progression.
authors.affiliation: Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America; San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America.
authors.forename: Sei J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America; San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America; Jewish Home of San Francisco, San Francisco, California, United States of America.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America; Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America; Department of Neurology, University of California San Francisco, San Francisco, California, United States of America; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America; San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America.
authors.forename: Irena
authors.initials: I
authors.lastname: Stijacic Cenzer
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America; Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Barnes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000503:physiopathology*; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index