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Retrospective Identification and Characterization of Mild Cognitive Impairment From a Prospective Population Cohort

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Objectives

Mild cognitive impairment (MCI) case-finding criteria have low specificity in general population studies. This study retrospectively identifies cases of MCI and determines baseline criteria giving the highest discriminability. The ability of these criteria to increase current case detection specificity is estimated.

Design

A population-based cohort was recruited from electoral rolls from three French cities. Clinical and environmental characteristics were evaluated at baseline and at 2- and 4-year follow-up. The clinical characteristics of incident cases of dementia were examined retrospectively.

Participants

Eight thousand nine hundred nineteen persons aged 65 years and older without dementia (60.8% women) were included in this study. The mean age (SD) of the participants was 74.2 (5.6) years for men and 74.4 (5.6) years for women.

Results

Three hundred twenty persons (3.6%) were retrospectively classified as MCI at baseline. This MCI group had poorer performance on all cognitive tests compared with the rest of the cohort, and a subsample undergoing MRI were found to have more white matter hyperintensities. The group were also characterized by the presence of an ApoE ɛ4 genotype (odds ratio [OR]: 2.17, confidence interval [CI]: 1.44–3.29 for men; OR: 2.27, CI: 1.59–3.24 for women) and instrumental activities of daily living loss (OR: 1.72, CI: 1.01–3.0 for men; OR: 1.49; CI: 0.97–2.3 for women). Women with MCI also had high depressive symptomatology (OR: 1.96; CI: 1.34–2.87), anticholinergic drug use (OR: 1.59; CI: 1.05–2.28), and low body mass index (OR: 1.54, CI: 1.05–2.28) and for men a history of stroke (OR: 2.17, CI: 1.16–4.05) and glycemia (OR: 1.72, CI: 1.13–2.71). Addition of these characteristics to conventional MCI definitions increases their specificity.

Conclusions

This general population study using a retrospective method for classifying persons with MCI identified gender-specific noncognitive clinical variables that may increase specificity.

Section snippets

PARTICIPANTS

Subjects for this study were recruited randomly from the electoral roles of three French cities (Bordeaux, Dijon, and Montpellier) between 1999 and 2001 as part of a multisite cohort study of community-dwelling persons aged 65 years and older (the Three-City Study). Subjects were interviewed initially either at a study center or in their own homes if disabled. The cohort was followed up twice at 2-year intervals. Given that cognitive impairment may commence up to 20 years before the diagnosis

Sociodemographic and Clinical Variables

A standardized interview included questions relating to sociodemographic characteristics, physical activities, weight, and height. Information was also obtained on exposure to anesthesia in the preceding year, subjectively evaluated health (six items relating to inhabitual difficulties in everyday activities, related to learning, calculating, language, and orientation), sleep quality, herpes infections, subjective report of appetite loss, self-reported social isolation, current alcohol

RESULTS

Within this sample, 320 persons (192 women) without dementia at baseline were diagnosed with dementia at one of the two follow-up examinations. The subjects in the Dem-MCI group are older than the comparison group (78 versus 74 years). Table 1 compares the clinical characteristics of the Dem-MCI group at baseline with those who did not develop dementia. Dem-MCI subjects were found to differ on a number of clinical and sociodemographic characteristics, notably, higher age, lower education, ApoE

DISCUSSION

In this study, we have chosen to substitute the usual definition of MCI based on cross-sectional statistical criteria for cognitive dysfunction by a pragmatic definition that comes closer to the clinical meaning of this concept, i.e., nondemented elderly persons in a predementia phase (Dem-MCI). Comparing our Dem-MCI cases at baseline with the remainder of the nondemented population, we found, not surprisingly, significant differences on all the cognitive domains tested. Our principal interest

CONCLUSION

Prospective studies may provide a more clinically relevant method of identifying persons with MCI by redefining it as persons without dementia who will develop the disorder within a short time period. From this alternative MCI cohort, we have been able to identify a number of gender-specific noncognitive clinical variables, which may increase the specificity of current case-finding procedures. Although the limitations of our study and the need for validation in other cohorts would prevent us

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    The authors thank the Génopôle of Lille, the Laboratories of Biochemistry of the University Hospitals of Dijon (Pr. Gambert) and Montpellier (Dr. Dupuy), the Town Council of Dijon, the Conseil Général of Côte d'Or, and the clinical case validation committee of the 3C study.

    The 3C Study was conducted under a partnership agreement between Inserm, the Victor Segalen–Bordeaux II University, and Sanofi-Synthélabo. The Fondation pour la Recherche Médicale funded the preparation and first phase of the study. The 3C-Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, the Institut de la Longévité, Agence Française de Sécurité Sanitaire des Produits de Santé, the Regional Governments of Aquitaine, Bourgogne and Languedoc-Roussillon, and the Fondation de France, France Alzheimer, the Ministry of Research-Inserm Programme “Cohorts and collection of biological material.” The Lille Génopôle received an unconditional grant from Eisai.

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