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Determinants, MRI correlates, and prognosis of mild cognitive impairment: the Rotterdam Study
Renée F A G de Bruijn1, Saloua Akoudad2, Lotte G M Cremers3
1Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Abstract:
Mild cognitive impairment (MCI) marks a transitional stage between healthy aging and dementia, but the understanding of MCI in the general population remains limited. We investigated determinants, MRI-correlates, and prognosis of MCI within the population-based Rotterdam Study. Firstly, we studied age, APOE-ε4 carriership, waist circumference, hypertension, diabetes mellitus, total and HDL-cholesterol levels, smoking, and stroke as potential determinants of MCI. Determinants were assessed cross-sectionally at baseline (2002-2005) and up to 7 years prior to baseline (1997-2001). Secondly, we compared volumetric, microstructural, and focal MRI-correlates in persons with and without MCI. Thirdly, we followed participants for incident dementia and mortality until 2012. Out of 4,198 participants, 417 had MCI, of whom 163 amnestic and 254 non-amnestic MCI. At baseline, older age, APOE-ε4 carriership, lower total cholesterol levels, and stroke were associated with MCI. Additionally, lower HDL-cholesterol levels and smoking were related to MCI when assessed 7 years prior to baseline. Persons with MCI, particularly those with non-amnestic MCI, had larger white matter lesion volumes, worse microstructural integrity of normal-appearing white matter, and a higher prevalence of lacunes, compared to cognitively healthy participants. MCI was associated with an increased risk of dementia (hazard ratio (HR) 3.98, 95% confidence interval (CI) 2.97;5.33), Alzheimer's disease (HR 4.03, 95% CI 2.92;5.56), and mortality (HR 1.54, 95% CI 1.28;1.85). In conclusion, we found that several vascular risk factors and MRI-correlates of cerebrovascular disease were related to MCI in the general population. Participants with MCI had an increased risk of dementia, including Alzheimer's disease, and mortality.
Insights
Mild cognitive impairment (MCI) is linked to vascular risk factors and brain changes. Individuals with MCI face a higher risk of dementia, including Alzheimer's disease, and mortality.
Area of Science:
- Neurology
- Epidemiology
- Neuroimaging
Background:
- Mild cognitive impairment (MCI) represents a critical transitional phase between normal aging and dementia.
- Understanding the determinants, neuroimaging correlates, and prognostic implications of MCI in the general population is crucial.
Purpose of the Study:
- To investigate the determinants, MRI-correlates, and prognosis of MCI within the population-based Rotterdam Study.
- To identify associations between vascular risk factors and MCI.
- To examine the relationship between MCI and subsequent risks of dementia and mortality.
Main Methods:
- Cross-sectional assessment of potential MCI determinants including age, APOE-ε4 carriership, waist circumference, hypertension, diabetes, cholesterol levels, smoking, and stroke.
- Comparison of volumetric, microstructural, and focal MRI findings in participants with and without MCI.
- Longitudinal follow-up for incident dementia and mortality until 2012.
Main Results:
- Older age, APOE-ε4 carriership, lower total cholesterol, and stroke were associated with MCI at baseline.
- Lower HDL-cholesterol and smoking predicted MCI up to 7 years prior to baseline.
- MCI, particularly non-amnestic MCI, correlated with increased white matter lesions, reduced white matter integrity, and lacunes.
- MCI significantly increased the risk of dementia (HR 3.98), Alzheimer's disease (HR 4.03), and mortality (HR 1.54).
Conclusions:
- Vascular risk factors and MRI indicators of cerebrovascular disease are associated with MCI in the general population.
- MCI is a significant predictor of future dementia, including Alzheimer's disease, and increased mortality.
- These findings underscore the importance of managing vascular health to potentially mitigate MCI progression and its adverse outcomes.