Predictive validity and diagnostic stability of mild cognitive impairment subtypes |
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| Affiliation: | 1. Department of Psychological Sciences (BLP), Kansas State University, Manhattan, KS;2. Department of Psychiatry (VW, BMF, SMS, IE, RHP), Yale University School of Medicine, New Haven, CT;3. U.S. Department of Veterans Affairs, VA Pacific Islands Healthcare System (JMW), Honolulu, HI;4. University of Hawaii School of Medicine (JMW), Manoa, HI;5. U.S. Department of Veterans Affairs, Clinical Neurosciences Division (BMF, SMS, RHP), National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT;1. Department of Neurology, Methodist Neurological Institute and Houston Methodist Hospital Research Institute for Academic Medicine, Houston, TX, USA;2. Department of Neurology, Weill Cornell Medical College, Cornell University, New York, NY, USA;3. Sleep Laboratory Houston Methodist Hospital, Houston, TX, USA;4. Department of Neurosurgery, Methodist Neurological Institute and Houston Methodist Hospital Research Institute for Academic Medicine, Houston, TX, USA;5. Department of Neurosurgery, Weill Cornell Medical College, Cornell University, New York, NY, USA;6. Department of Radiology MRI Core, Houston Methodist Hospital and Methodist Research Institute for Academic Medicine, Houston, TX, USA;7. Department of Radiology, Weill Cornell Medical College, Cornell University, New York, NY, USA. |
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| Abstract: | BackgroundMild cognitive impairment (MCI) is subclassified into four subtypes by the presence of impairment in the memory domain (amnestic vs nonamnestic) and the number of impaired cognitive domains (single vs multiple). However, predictive validity for outcomes of these criteria and the diagnostic stability of the subtypes are questionable.MethodsWe investigated the outcomes of 140 patients with MCI who participated in the baseline study of the Korean Longitudinal Study on Health and Aging and completed the 18-month follow-up evaluation (mean duration of follow-up = 1.57 ± 0.24 years). We evaluated the predictive validity of the criteria using multinomial logistic regression analyses, and the diagnostic stability of MCI subtypes using annual conversion rates between subtypes.ResultsCompared with the single-domain type (MCIs), the multiple-domain type (MCIm) had a lower chance of reversion to normal cognition (MCIm = 10.94%, MCIs = 43.42%) and higher risk of conversion to dementia (MCIm = 23.44%, MCIs = 5.26%). The difference in the reversion rate between the multiple- and single-domain type was statistically significant (odds ratio = 0.233, 95% confidence interval = 0.070–0.771, P = .017). However, neither the chance of reversion nor the risk of conversion was different between amnestic and nonamnestic subtypes. Among the 81 participants who neither converted to dementia nor reverted to normal cognition, 39 converted to different subtype (annual conversion rate = 17.74%).ConclusionsThe number of impaired cognitive domains, but not the presence of memory impairment, predicted poor outcomes in people with MCI. However, MCI subtype was diagnostically unstable. |
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