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Neuropsychological Prediction of Conversion to Alzheimer Disease in Patients With Mild Cognitive Impairment

Matthias H. Tabert; Jennifer J. Manly; Xinhua Liu; Gregory Pelton; Sara Rosenblum; Marni Jacobs; Diana Zamora; Madeleine Goodkind; Karen L. Bell; Yaakov Stern; Devangere P. Devanand

Title:
Neuropsychological Prediction of Conversion to Alzheimer Disease in Patients With Mild Cognitive Impairment
Author(s):
Tabert, Matthias H.
Manly, Jennifer J.
Liu, Xinhua
Pelton, Gregory
Rosenblum, Sara
Jacobs, Marni
Zamora, Diana
Goodkind, Madeleine
Bell, Karen L.
Stern, Yaakov
Devanand, Devangere P.
Date:
Type:
Articles
Department(s):
Taub Institute
Volume:
63
Persistent URL:
Book/Journal Title:
JAMA Psychiatry
Publisher:
American Medical Association
Abstract:
Context: The likelihood of conversion to Alzheimer disease (AD) in mild cognitive impairment (MCI) and the “optimal” early markers of conversion need to be established. Objectives: To evaluate conversion rates to AD in subtypes of MCI and to identify neuropsychological measures most predictive of the time to conversion. Design: Patients were followed up semiannually and controls annually. Subtypes of MCI were determined by using demographically adjusted regression norms on neuropsychological tests. Survival analysis was used to identify the most predictive neuropsychological measures. Setting: Memory disorders clinic. Participants: One hundred forty-eight patients reporting memory problems and 63 group-matched controls. Main Outcome Measure: A consensus diagnosis of probable AD. Results: At baseline, 108 patients met criteria for amnestic MCI: 87 had memory plus other cognitive domain deficits and 21 had pure memory deficits. The mean duration of follow-up for the 148 patients was 46.6 ± 24.6 months. In 3 years, 32 (50.0%) of 64 amnestic-“plus” and 2 (10.0%) of 20 “pure” amnestic patients converted to AD (P = .001). In 148 patients, of 5 a priori predictors, the percent savings from immediate to delayed recall on the Selective Reminding Test and the Wechsler Adult Intelligence Scale–Revised Digit Symbol Test were the strongest predictors of time to conversion. From the entire neuropsychological test battery, a stepwise selection procedure retained 2 measures in the final model: total immediate recall on the Selective Reminding Test (odds ratio per 1-point decrease, 1.10; 95% confidence interval, 1.05-1.14; P<.0001) and Digit Symbol Test coding (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P = .01). The combined predictive accuracy of these 2 measures for conversion by 3 years was 86%. Conclusions: Mild cognitively impaired patients with memory plus other cognitive domain deficits, rather than those with pure amnestic MCI, constituted the high-risk group. Deficits in verbal memory and psychomotor speed/executive function abilities strongly predicted conversion to AD.
Subject(s):
Mild cognitive impairment
Alzheimer's disease
Cognition
Older people--Mental health
Amnestic mild cognitive impairment
Neuropsychology
Dementia
Mental health
Neurosciences
Gerontology
Publisher DOI:
https://doi.org/10.1001/archpsyc.63.8.916
Item views
91
Metadata:
text | xml
Suggested Citation:
Matthias H. Tabert, Jennifer J. Manly, Xinhua Liu, Gregory Pelton, Sara Rosenblum, Marni Jacobs, Diana Zamora, Madeleine Goodkind, Karen L. Bell, Yaakov Stern, Devangere P. Devanand, , Neuropsychological Prediction of Conversion to Alzheimer Disease in Patients With Mild Cognitive Impairment, Columbia University Academic Commons, .

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