# Presentation: 016828

## MCI Conversion to Dementia:Clinic and Community-Based Studies

- Ranjan Duara, M.D.
- Wien Center for Alzheimer’s Disease & Memory Disorders, Miami Beach

## Collaborators

- Wien Center, Mount Sinai, Miami Beach
- Ranjan Duara, MD, David Loewenstein, PhD
- Amarilis Acevedo, PhD, Warren Barker, MS
- Debbie Hurwitz, MSW, Marina Bravo, MSW
- Mercy Luis, MSW, Cheryl Luis, PhD
- Roskamp Institute, USF, Tampa
- Michael Mullan, MD, PhD, Fiona Crawford, PhD
- University of Toronto
-  Peter St. George-Hyslop, MD

## MCI to Dementia ConversionDemographics of Clinic Sample

| MCI With Followup (n) | 210 |
| --- | --- |
| Age of Onset (yrs) | 72  9 |
| MMSE | 25  3  |
| Diagnosis (% AD) | 59% |
| Followup Interval (yrs) | 1.9  1.8 |
| Followup Rate (%) | 25.5% |

## MCI Study: Non-AD Diagnoses

| Diagnosis | Number / % |
| --- | --- |
| Vascular Cognitive Impairment | 32  / 37% |
| Psychiatric Disorders (depression, etc) | 11 / 13% |
| Other Degenerative
(FTD, Parkinsons, etc) | 8 / 9% |
| Other Neurological
(seizure, hydrocephalus, etc.) | 35 / 41% |

## Criteria for MCI

- History of cognitive impairment (subjective, collateral, or both)
- Objective cognitive deficits on memory  other cognitive domains
- Lacking DSM III criteria for dementia
- Preserved functional capacity

## Criteria for MCI (AD)

- Meets criteria for MCI
- Meeting NINCDS-ADRDA criteria for AD, but lacking DSM III criteria for dementia

## Criteria for Conversion of MCI to Dementia in Clinic Sample

- Worsening of cognitive function by collateral report
- Worsening of objective cognitive deficits
- Meets DSM III criteria for dementia

## APOE 4 Allele Frequencyin Clinic Samples

| Diagnosis | 4 Frequency (%) |
| --- | --- |
| Probable AD (n=678) | 29% |
| MCI – AD (n=195) | 26% |
| MCI – Other (n=138) | 14% |

## Conversion to DementiaEffect of AD Diagnosis

- 2=6.8 (p=.009)

## MCI to DementiaConversion Rates in Clinic Sample

|  | 1-yr Rate | 2-yr Rate | 3-yr Rate |
| --- | --- | --- | --- |
| ALL MCI
(n=210) | 17% | 31% | 47% |
| MCI - AD
(n=124) | 23% | 41% | 58% |
| MCI - Non-AD (n=86) | 11% | 21% | 34% |

- 2=6.8	(p=.009) for survival curve difference of AD vs non-AD

## Conversion to DementiaEffect of APOE

- 2=3.6 (p=.06)

- 2=3.6 (p=.06)

## Conversion to DementiaEffect of Age

- 2=0.4 (p=.83)

## Factors Influencing Follow-Up Rate in MCI Patients

| Predictor | Data | P-value |
| --- | --- | --- |
| Gender | 26% (m)  23%(f) | n.s. |
| AD Diagnosis | 32%(MCI-AD) 
20% (MCI-non-AD) | .006 |
| Age at Onset of MCI | 24% (60s)  29% (70s)
21% (80+) | .16 |
| Initial MMSE  | 24.4 (followup+)
 24.9 (no followup) | n.s. |
| Initial HDRS (fup+/-) | 8.4 (followup+)
8.7 (followup-) | n.s. |

## MCI to DementiaRisk Factors in Clinic Sample

***No Association***
- Age of onset
- Use of Aricept
- Education
- Gender

***Increased Risk***
- Diagnosis of AD
- APOE 4 (*trend*)

## Classification of Screening Sample

| Classifi-cation | MMSE 
(0-30) | 4 Trial Recall (0-12) | APOE 4 Allele Frequency |
| --- | --- | --- | --- |
| Normal | 24 | 10 | 12% |
| MCI | 24
<24 | 5-9
>4 | 18% |
| Demented | <24 | 4 | 26% |

## MCI to Dementia Conversion

**11%**

**15%**

**20%**