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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Prognosis of mild cognitive impairment in general practice: results of the German AgeCoDe study
Hanna Kaduszkiewicz1, Marion Eisele, Birgitt Wiese
1Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany (Kaduszkiewicz, Eisele, van den Bussche, Scherer); Hannover Medical School, Hannover, Germany (Wiese, Prokein); Institute of Primary Medical Care, University Medical Center Schleswig-Holstein (Kaduszkiewicz); Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany (Luppa, Luck, Riedel-Heller); Department of Psychiatry, University of Bonn, Germany (Jessen, Maier); Department of Psychiatry, Technical University of Munich, Germany (Bickel, Mösch); Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany (Pentzek, Fuchs); Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany (Eifflaender-Gorfer, Weyerer); Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Germany (König, Brettschneider); German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (Maier, Jessen).
Purpose:
The concept of mild cognitive impairment (MCI) has recently been introduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as mild neurocognitive disorder, making it a formal diagnosis. We investigated the prognostic value of such a diagnosis and analyzed the determinants of the future course of MCI in the AgeCoDe study (German Study on Ageing, Cognition, and Dementia in Primary Care Patients).
Methods:
We recruited 357 patients with MCI aged 75 years or older from primary care practices and conducted follow-up with interviews for 3 years. Depending on the course of impairment over time, the patients were retrospectively split into 4 groups representing remittent, fluctuating, stable, and progressive courses of MCI. We performed ordinal logistic regression analysis and classification and regression tree (CART) analysis.
Results:
Overall, 41.5% of the patients had remission of symptoms with normal cognitive function 1.5 and 3 years later, 21.3% showed a fluctuating course, 14.8% had stable symptoms, and 22.4% had progression to dementia. Patients were at higher risk for advancing from one course to the next along this spectrum if they had symptoms of depression, impairment in more than 1 cognitive domain, or more severe cognitive impairment, or were older. The result on a test of the ability to learn and reproduce new material 10 minutes later was the best indicator at baseline for differentiating between remittent and progressive MCI. Symptoms of depression modified the prognosis.
Conclusions:
In primary care, about one-quarter of patients with MCI have progression to dementia within the next 3 years. Assessments of memory function and depressive symptoms are helpful in predicting a progressive vs a remittent course. When transferring the concept of MCI into clinical diagnostic algorithms (eg, DSM-5), however, we should not forget that three-quarters of patients with MCI stayed cognitively stable or even improved within 3 years. They should not be alarmed unnecessarily by receiving such a diagnosis.
Insights
Mild cognitive impairment (MCI) diagnosis shows varied outcomes. About one-quarter progress to dementia in 3 years, but most remain stable or improve. Depression and memory function predict progression.
Area of Science:
- Gerontology
- Neuroscience
- Primary Care Medicine
Background:
- Mild cognitive impairment (MCI) is now a formal diagnosis in the DSM-5 as mild neurocognitive disorder.
- Understanding the long-term prognosis and variability of MCI is crucial for patient management and clinical practice.
Purpose of the Study:
- To investigate the prognostic value of a mild cognitive impairment (MCI) diagnosis.
- To analyze the determinants influencing the future course of MCI in older primary care patients.
Main Methods:
- 357 patients aged 75+ with MCI were recruited from primary care and followed for 3 years.
- Patients were categorized into remittent, fluctuating, stable, or progressive MCI courses.
- Ordinal logistic regression and classification and regression tree (CART) analyses were employed.
Main Results:
- 41.5% of patients experienced remission, 22.4% progressed to dementia, 21.3% had fluctuating symptoms, and 14.8% remained stable.
- Higher risk for progression was associated with depression, multi-domain cognitive impairment, older age, and more severe cognitive deficits.
- Baseline memory function and depressive symptoms were key predictors of MCI course.
Conclusions:
- Approximately 25% of primary care patients with MCI progress to dementia within 3 years.
- Memory function and depression assessment aid in predicting progressive versus remittent MCI.
- Clinicians should note that most MCI patients remain stable or improve, avoiding unnecessary patient alarm.
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