Is Mortality Increased in Mildly Cognitively Impaired Individuals?

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Abstract

Numerous studies have focused on the effect of mild cognitive impairment in elderly people. However, the impact of mild cognitive impairment on mortality has rarely been considered so far. This paper reviews recent work on mild cognitive impairment and its mortality risk. Relevant articles were identified by a systematic search of the literature published since 1990 using the databases PubMed, Web of Science and PSYNDEXplus, bibliographies of articles identified and of earlier reviews. Those studies were considered which predominantly included persons aged 65 and over and which relied on population-based samples. Thus only eight studies could be identified. In general, the relative risk (RR) for subjects with mild cognitive impairment according to different concepts in comparison to non-affected persons varies from 1.0 to 1.9. However, only few studies are available, and a comparison of the literature is problematic, due to variations in criteria and methodology.

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Most cited references 24

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Age‐associated memory impairment: Proposed diagnostic criteria and measures of clinical change — report of a national institute of mental health work group

Thomas Crook, Raymond Bartus, Steven Ferris … (1986)

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Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals.

S Thibodeau, D Schaid, R Ivnik … (1995)

The outcome of patients with mild cognitive impairment is not known, yet these patients present a difficult dilemma for the clinician. This study was designed to characterize the outcome of a group of patients with mild cognitive impairment and to determine whether the presence of the epsilon 4 allele on the apolipoprotein E gene (APOE) is a predictor of that outcome. A prospective, longitudinal inception cohort. General community clinic. A consecutive sample of 66 patients who met criteria for a diagnosis of a mild cognitive impairment and who had at least one clinical reevaluation was identified from the Mayo Clinic Alzheimer's Disease Center/Alzheimer's Disease Patient Registry. We evaluated patients initially and at 12- to 18-month intervals up to 54 months using standard neurological and neuropsychological measures such as the Mini-Mental State Examination, the Dementia Rating Scale, the Wechsler Adult Intelligence Scale--Revised, the Wechsler Memory Scale--Revised, and the Free and Cued Selective Reminding Test. The APOE status of study patients was determined. The development of dementia as determined by the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition and the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria. Sixty-six individuals had been reevaluated once (mean of 18 months), 36 individuals twice (mean of 36 months), and 22 individuals on three occasions (mean of 54 months), with conversion rates to dementia at these intervals of 24%, 44%, and 55%, respectively. A multivariate Cox regression model demonstrated that possession of an APOE epsilon 4 allele was the strongest predictor of clinical outcome. These data suggest the following: (1) patients with mild cognitive impairment can be clinically defined, (2) many members of this group progress to Alzheimer's disease, and (3) APOE epsilon 4 allele status appears to be a strong predictor of clinical progression.

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Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature.

P Saz, M. Dewey (2001)

No recent attempt has been made to synthesise information on mortality and dementia despite the theoretical and practical interest in the topic. Our objective was to estimate the influence on mortality of cognitive impairment and dementia. Data sources were Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from health care facilities were excluded. The search located 68 community studies. Effect sizes were extracted from the studies and if they were not included in the published studies, effect sizes were calculated where possible: this was possible for 23 studies of cognitive impairment and 32 of dementia. No attempt was made to contact authors for missing data. For the studies of cognitive impairment Fisher's method (a vote counting method), gave a p-value (from eight studies) of 0.00001. For studies of dementia, age-adjusted confidence intervals (CI) were pooled (odds ratio (OR) 2.63 with 95% CI 2.17 to 3.21 from six studies). Levels of cognitive impairment commonly found in community studies give rise to an increased risk of mortality, and this appears to be true even for quite mild levels of impairment. The analysis confirms the increased risk of mortality for dementia, but reveals a dearth of information on the causes of the excess mortality and on possible effect modification by age, dementia subtype or other variables. Copyright 2001 John Wiley & Sons, Ltd.

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Journal

Journal ID (publisher-id): DEM

Journal ID (nlm-ta): Dement Geriatr Cogn Disord

Journal ID (doi): 10.1159/issn.1420-8008

Title: Dementia and Geriatric Cognitive Disorders

Publisher: S. Karger AG

ISSN (Print): 1420-8008

ISSN (Electronic): 1421-9824

Publication date Subscription-year: 2006

Publication date (Print): May 2006

Publication date (Electronic): 12 May 2006

Volume: 21

Issue: 5-6

Pages: 403-410

Affiliations

Klinik und Poliklinik für Psychiatrie der Universität Leipzig, Leipzig, Germany

Article

Publisher ID: 92846 Other ID: Dement Geriatr Cogn Disord 2006;21:403–410

DOI: 10.1159/000092846

PubMed ID: 16645273

SO-VID: d05ea451-a49e-414a-9d9a-243f5750332d

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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.

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Date received : 10 June 2005

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Tables: 1, References: 49, Pages: 8

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Is Mortality Increased in Mildly Cognitively Impaired Individuals?

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Most cited references 24

Age‐associated memory impairment: Proposed diagnostic criteria and measures of clinical change — report of a national institute of mental health work group

Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals.

Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature.

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