Factors Predicting Reversion from Mild Cognitive Impairment to Normal Cognitive Functioning: A Population-Based Study

Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
PLoS ONE (Impact Factor: 3.23). 03/2013; 8(3):e59649. DOI: 10.1371/journal.pone.0059649
Source: PubMed


Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. However, many individuals diagnosed with MCI are found to have reverted to normal cognition on follow-up. This study investigated factors predicting or associated with reversion from MCI to normal cognition.
Our analyses considered 223 participants (48.9% male) aged 71-89 years, drawn from the prospective, population-based Sydney Memory and Ageing Study. All were diagnosed with MCI at baseline and subsequently classified with either normal cognition or repeat diagnosis of MCI after two years (a further 11 participants who progressed from MCI to dementia were excluded). Associations with reversion were investigated for (1) baseline factors that included diagnostic features, personality, neuroimaging, sociodemographics, lifestyle, and physical and mental health; (2) longitudinal change in potentially modifiable factors.
There were 66 reverters to normal cognition and 157 non-reverters (stable MCI). Regression analyses identified diagnostic features as most predictive of prognosis, with reversion less likely in participants with multiple-domain MCI (p = 0.011), a moderately or severely impaired cognitive domain (p = 0.002 and p = 0.006), or an informant-based memory complaint (p = 0.031). Reversion was also less likely for participants with arthritis (p = 0.037), but more likely for participants with higher complex mental activity (p = 0.003), greater openness to experience (p = 0.041), better vision (p = 0.014), better smelling ability (p = 0.040), or larger combined volume of the left hippocampus and left amygdala (p<0.040). Reversion was also associated with a larger drop in diastolic blood pressure between baseline and follow-up (p = 0.026).
Numerous factors are associated with reversion from MCI to normal cognition. Assessing these factors could facilitate more accurate prognosis of individuals with MCI. Participation in cognitively enriching activities and efforts to lower blood pressure might promote reversion.

Download full-text


Available from: Darren Lipnicki
  • Source
    • "AD is the most frequent cause of dementia and the amnestic type of MCI often represents a prodromal stage of AD, especially late onset AD and particularly in the presence of biomarkers typical for AD [3]. Additionally, many persons diagnosed with MCI do not have any of these conditions and show normal cognitive function at follow up [4]. According to a prevailing model, AD begins with amyloid(A ) deposition in cortex, leading to a synaptic dysfunction , neurodegeneration, and finally to detectable cognitive changes and functional decline in activities of daily life associated with early dementia [5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: There is a need to find very early markers for pre-clinical Alzheimer's disease as interventions early in the disease process are thought to be most effective. Objective: The present study aimed to address the potential relation between cerebrospinal fluid (CSF) biomarkers and reduced cognitive function in a relatively young cohort of memory clinic patients with subjective cognitive decline. Methods: 122 patients (mean age 63 years) with subjective cognitive decline were recruited from two university memory clinics and followed for two years. Results: The main finding was that the subgroup with objective memory decline during the study period had significantly higher T-tau at baseline than the group with improved memory. Baseline CSF variables showed a trend toward more pathological values in the patients with memory decline compared to those who improved or remained stable. The baseline memory score of those who declined was significantly better than the baseline score of those who improved over two years. The general trend for the whole group was improved memory and executive test scores. There were no differences in cognitive scores based on CSF quartiles at baseline, nor were there differences in cognitive outcome for patients with early amnestic mild cognitive impairment versus average cognitive function at baseline. Conclusions: The main finding that T-tau rather than amyloid-β was associated with memory decline do not support the prevailing opinion about the chain of events assumed to take place in Alzheimer's disease. In addition, memory decline was not associated with poor baseline memory score. Thus, a memory cut-off indicating low baseline memory would not would have identified the declining group.
    Full-text · Article · Sep 2015 · Journal of Alzheimer's disease: JAD
  • [Show abstract] [Hide abstract]
    ABSTRACT: Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. This is clinically relevant overt dementia can be prevented if treatment strategies are devised for MCI. Neuropsychological deficits in this condition are very common and are important clinically for treatment and outcomes. We aimed to review various neuropsychological deficits in MCI. Further, we have presented the current evidence for nosological status, neuroanatomical basis, and clinical outcome of this heterogeneous construct. All published papers on the topic of neuropsychological deficits in MCI on Medline and other databases were reviewed. A wide range of memory and executive function deficits are common in MCI patients. However, several studies are limited by either improper designs or inadequate sample sizes. Several neuropsychological impairments like memory function and executive functions can be diagnosed in MCI. The evidence base for the exact neuroanatomical basis of MCI is not robust yet. However, given the wide range of outcomes, controversies and debates exist regarding the nosological significance of the deficits. Hence, more studies are needed to specifically locate the impairments and further delineate the construct of MCI.
    No preview · Article · Mar 2013 · Annals of Indian Academy of Neurology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine acute effects of intranasal insulin on regional cerebral perfusion and cognition in older adults with type 2 diabetes.Research design and methodsThis was a proof-of-concept, randomized, double-blind, placebo-controlled intervention evaluating the effects of a single 40IU dose of insulin or saline on vasoreactivity and cognition in 15 diabetic and 14 control subjects. Measurements included regional perfusion, vasodilatation to hypercapnia at 3 Tesla MRI and neuropsychological evaluation.ResultsIntranasal insulin administration was well tolerated and did not affect systemic glucose levels. No serious adverse events were reported. Across all subjects, intranasal insulin improved visuospatial memory (p<0.05). In the diabetes group, an increase of perfusion after insulin administration was greater in the insular cortex as compared to the control group (p=0.0003). Cognitive performance following insulin administration was related to regional vasoreactivity. Improvements of visuospatial memory after insulin administration in the diabetes group (R(2)adj=0.44, p=0.0098) and of verbal fluency test in the control group (R(2)adj =0.64, p=0.0087) were correlated with vasodilatation in the middle cerebral artery territory.Conclusions Intranasal insulin administration appears safe and does not affect systemic glucose control, and may provide acute improvements of cognitive function in patients with type 2 diabetes, potentially through vasoreactivity mechanisms. Intranasal insulin-induced changes in cognitive function may be related to vasodilatation in the anterior brain regions, such as insular cortex that regulates attention-related task performance. Larger studies are warranted to identify long-term effects and predictors of positive cognitive response to intranasal insulin therapy.
    Full-text · Article · Oct 2013 · Diabetes care
Show more