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      Prevalence and Incidence of Mild Cognitive Impairment across Subtypes, Age, and Sex

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          Abstract

          Objective: The purpose of this study was to report on the prevalence and incidence of mild cognitive impairment (MCI) across age, sex, and subtypes according to various criteria in a population-based sample. Methods: The sample was drawn from the Swedish Good Aging in Skåne (GÅS) population study, and data from 3,752 participants aged 60 years and more were used to calculate the MCI prevalence. The incidence was calculated using 2,093 participants with 6-year follow-up data. MCI was defined according to the expanded Mayo Clinic criteria: cognitive complaint, objective cognitive impairment (two different criteria depending on the severity of impairment), preserved functional abilities, and no dementia. Results: The prevalence estimates ranged from 5.13 to 29.9% depending on age and severity of impairment. The incidence rates of overall MCI were 22.6 (95% confidence interval [CI]: 19.6–25.9) and 8.67 (95% CI: 7.0–10.7) per 1,000 person-years for less severe and severe cognitive impairment, respectively. The highest prevalence and incidence estimates were found for “non-amnestic MCI single domain.” The older age groups had a higher prevalence, and no sex or age differences in MCI incidence were detected. Conclusion: Our findings concur with previous research advocating that MCI is a heterogeneous concept, since the prevalence and incidence estimates differed substantially according to age, MCI subtype, and severity of cognitive impairment.

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          Most cited references29

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          Frequency and course of mild cognitive impairment in a multiethnic community.

          To examine incidence rates and antecedents of mild cognitive impairment (MCI) and Alzheimer's disease (AD) among diverse elders without dementia at the initial visit, and to examine the characteristics of elders with MCI who reverted to normal on follow-up examination. A total of 2,364 Caribbean Hispanic, black, or non-Hispanic white subjects, aged 65 or older, who were free of dementia at initial evaluation were followed up every 18 to 24 months. Incidence rate of MCI and AD was determined by examination of neurological, medical, psychiatric, and neuropsychological function. Over 10,517 person-years, 21% of normal elderly subjects progressed to MCI (annual incidence rate, 5.1%; 95% confidence interval, 4.6-5.6%). Of those with MCI initially, 21.8% were subsequently diagnosed with AD (annual incidence rate, 5.4%; 95% confidence interval, 4.7-6.3%), 47% remained unchanged, and 31% reverted to normal. Those with MCI were 2.8 times more likely to experience development of AD than normal elderly subjects. MCI with impairment in memory and at least one other cognitive domain was associated with greatest risk for progression to AD and was also least likely to revert to normal at follow-up. Consistent diagnosis of MCI or incident probable or possible AD was 60% sensitive and 94% specific for the pathological diagnosis of AD. Impaired memory and language were useful predictors of transition to AD. Reversion to normal from MCI was frequent, but those with impairment in more than one cognitive domain were more likely to progress or remain impaired than those with single-domain impairment. Clinical diagnosis of MCI does not always predict AD neuropathology.
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            Incidence and outcome of mild cognitive impairment in a population-based prospective cohort.

            To estimate the age-specific incidence rate of mild cognitive impairment (MCI) according to sex and educational level and to explore the course of MCI, particularly its progression to AD, in a population-based cohort. A community-based cohort of nondemented elderly people (Personnes Agées QUID [PAQUID]) was followed longitudinally for 5 years. MCI was defined as memory complaints with objective memory impairment, without dementia, impairment of general cognitive functioning, or disability in activities of daily living. Incidence rates were calculated using the person-years method. A descriptive analysis at the different follow-up times was performed to study the course of MCI. At baseline, there were 58 prevalent cases of MCI (2.8% of the sample). During a 5-year follow-up, 40 incident cases of MCI occurred in 1,265 subjects at risk. The global incidence rate of MCI was 9.9/1,000 person-years. MCI was a good predictor of AD with an annual conversion rate of 8.3% and a good specificity, but it was very unstable over time: Within 2 to 3 years, only 6% of the subjects continued to have MCI, whereas >40% reverted to normal. Conventionally defined MCI has reasonable predictive value and specificity for AD. However, MCI was very unstable across time in this study. Furthermore, the definition of MCI seems to be too restrictive and should probably be extended to other categories of individuals also at high risk of developing AD.
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              Mild Cognitive Impairment: An Overview

              Mild cognitive impairment (MCI) refers to the transitional state between the cognitive changes of normal aging and very early dementia. MCI has generated a great deal of research from both clinical and research perspectives. Several population- and community-based studies have documented an accelerated rate of progression to dementia and Alzheimer's disease in individuals diagnosed with MCI. Clinical subtypes of MCI have been proposed to broaden the concept and include prodromal forms of a variety of dementias. An algorithm is presented to assist the clinician in identifying subjects and subclassifying them into the various types of MCI. Progression factors, including genetic, neuroimaging, biomarker, and clinical characteristics, are discussed. Neuropathological studies indicating an intermediate state between normal aging and early dementia in subjects with MCI are presented. The recently completed clinical trials as well as neuropsychological and nutritional interventions are discussed. Finally, the clinical utility of MCI, and directions for future research are proposed.
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                Author and article information

                Journal
                DEM
                Dement Geriatr Cogn Disord
                10.1159/issn.1420-8008
                Dementia and Geriatric Cognitive Disorders
                S. Karger AG
                1420-8008
                1421-9824
                2019
                October 2019
                16 July 2019
                : 47
                : 4-6
                : 219-232
                Affiliations
                Division of Geriatric Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
                Author notes
                *Marieclaire Overton, Jan Waldenströms gata 35, CRC, Building 28, fl.13, Skåne University Hospital, SE–205 02 Malmö (Sweden), E-Mail Marie_Claire.Overton@med.lu.se
                Article
                499763 Dement Geriatr Cogn Disord 2019;47:219–232
                10.1159/000499763
                31311017
                7b146c70-c23d-44f0-ac7a-2b7b825aefd3
                © 2019 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 21 January 2019
                : 20 March 2019
                Page count
                Figures: 2, Tables: 5, Pages: 14
                Categories
                Research Article

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Prevalence,Mild cognitive impairment,Diagnostic criteria,Incidence

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