title: Progression from normal cognition to mild cognitive impairment in a diverse clinic-based and community-based elderly cohort.
abstract: BACKGROUND
  Investigation of the conversion rates from normal cognition (NC) to mild cognitive impairment (MCI) is important, as effective early intervention could potentially prevent or substantially delay the onset of dementia. However, reported conversion rates differ across studies and recruitment source. Our study examined predictors of conversion from NC to MCI in a racially and ethnically diverse sample drawn both from community and clinic recruitment sources.
  
  
  METHODS
  Rates and predictors of conversion were assessed in an ongoing prospective longitudinal study at University of California, Davis, Alzheimer's Disease Center from 2000 to 2015. Participants (n = 254) were recruited through a clinic (5%) and community sample (95%). They were clinically confirmed as cognitively normal at baseline and followed up to seven years. Recruitment source, demographic factors (age, gender, race/ethnicity, year of education, APOE ε4 positive), cognitive measures (SENAS test scores), functional assessments (CDR sum of boxes), and neuroimaging measures (total brain volume, total hippocampal volume, white hyperintensity volume) were assessed as predictors of conversion from cognitively normal to mild cognitive impairment using proportional hazards models.
  
  
  RESULTS
  Of 254 participants, 62 (11 clinic, 51 community) progressed to MCI. The clinic-based sample showed an annual conversion rate of 30% (95% CI 17%-54%) per person-year, whereas the community-based sample showed a conversion rate of 5% (95% CI 3%-6%) per person-year. Risk factors for conversion include clinic-based recruitment, being older, lower executive function and worse functional assessment at baseline, and smaller total brain volume.
  
  
  CONCLUSIONS
  Older adults who sought out a clinical evaluation, even when they are found to have normal cognition, have increased risk of subsequent development of MCI. Results are consistent with other studies showing subjective cognitive complaints are a risk for future cognitive impairment, but extend such findings to show that those who seek evaluation for their complaints are at particularly high risk. Moreover, these individuals have subtle, but significant differences in functional and cognitive abilities that, in the presence of concerns and evidence of atrophy on by brain imaging, warrant continued clinical follow-up. These risk factors could also be used as stratification variables for dementia prevention clinical trial design.
authors: Department of Public Health Sciences, University of California, Davis, Davis, CA, USA.
authors: Yingjia
authors: Y
authors: Chen
authors: Department of Neurology, University of California, Davis, Davis, CA, USA.
authors: Katherine G
authors: KG
authors: Denny
authors: Department of Public Health Sciences, University of California, Davis, Davis, CA, USA.
authors: Danielle
authors: D
authors: Harvey
authors: Department of Neurology, University of California, Davis, Davis, CA, USA.
authors: Sarah Tomaszewski
authors: ST
authors: Farias
authors: Department of Neurology, University of California, Davis, Davis, CA, USA.
authors: Dan
authors: D
authors: Mungas
authors: Department of Neurology, University of California, Davis, Davis, CA, USA.
authors: Charles
authors: C
authors: DeCarli
authors: Department of Public Health Sciences, University of California, Davis, Davis, CA, USA. Electronic address: labeckett@ucdavis.edu.
authors: Laurel
authors: L
authors: Beckett
mesh_terms: D000367:Age Factors; D000368:Aged; D053327:Apolipoprotein E4 / Q000235:genetics; D001921:Brain / Q000000981:diagnostic imaging; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000235:genetics / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D009929:Organ Size; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D053327:Apolipoprotein E4
keywords: Alzheimer's disease; Cognitive complaints; Dementia; Mild cognitive impairment; Normal cognition; Progression