title: Markers for the risk of progression from mild cognitive impairment to Alzheimer's disease.
abstract: BACKGROUND
  Defining reliable markers of conversion to dementia could be the first step in order to identify appropriate treatment strategies for mild cognitive impairment (MCI) patients.
  
  
  OBJECTIVE
  To develop a tool able to predict the risk of progression from MCI to Alzheimer's disease (AD).
  
  
  METHODS
  406 MCI patients were included and followed for a one-year period. Demographic characteristics, vascular risk factors, extent of cerebrovascular lesions, markers of carotid atherosclerosis investigated with an ultrasonographic assessment (plaque index and intima-media thickness) and cerebrovascular reactivity to apnea (breath-holding index) were considered as potential predictors of conversion.
  
  
  RESULTS
  106 (26%) MCI patients showed a conversion to AD. Plaque index, intima-media thickness, and breath-holding index were relevant predictors of conversion (p = 0.042; p = 0.003; p < 0.001, multivariate logistic regression analysis). A simplified scoring system was devised based on the magnitude of the estimated multinomial logistic regression β coefficient results. A total score was calculated as the sum of each predictive factor which resulted in a 0-5 range. The optimal cut-off score was ≥3 (sensitivity, 23.6%, 95% CI 15.9%-32.8%; specificity, 97.7%, 95% CI 95.3%-99.1%; positive likelihood ratio, 10.1, 95% CI 4.5%-22.7%; negative likelihood ratio, 0.78, 95% CI 0.70%-0.87%). The AUC was 0.71 (95% CI, 0.65-0.77).
  
  
  CONCLUSIONS
  Our findings show the possibility to obtain a predictive indicator of the risk of conversion from MCI to dementia by considering the presence of both atherosclerotic changes in the carotid district and impairment of cerebral hemodynamics. Such an approach may allow us to formulate a correct prognosis in more than 70% of patients with amnesic MCI.
authors: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors: Laura
authors: L
authors: Buratti
authors: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors: Simona
authors: S
authors: Balestrini
authors: Neurology Unit, Campus Bio-Medico University, Rome, Italy.
authors: Claudia
authors: C
authors: Altamura
authors: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors: Giovanna
authors: G
authors: Viticchi
authors: Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Italy.
authors: Lorenzo
authors: L
authors: Falsetti
authors: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors: Simona
authors: S
authors: Luzzi
authors: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors: Leandro
authors: L
authors: Provinciali
authors: Neurology Unit, Campus Bio-Medico University, Rome, Italy.
authors: Fabrizio
authors: F
authors: Vernieri
authors: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors: Mauro
authors: M
authors: Silvestrini
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D015415:Biomarkers; D059168:Carotid Intima-Media Thickness; D002561:Cerebrovascular Disorders; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: Alzheimer's disease; atherosclerosis; carotid arteries; cerebral hemodynamics; mild cognitive impairment; ultrasonography