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"2-step MCI-AD": a simple scoring system to predict rapid conversion from mild cognitive impairment to Alzheimer
Antonio Muscari1, Fabio Clavarino1, Vincenzo Allegri2
1Department of Medical and Surgical Sciences - University of Bologna.
Background:
Several techniques are available to identify, among patients with mild cognitive impairment (MCI), those at risk of conversion to Alzheimer dementia (CAD). However, simple cost-effective methods to assess the risk are not available yet.
Methods:
This retrospective study included 143 MCI outpatients (76.6±5.2 years, 46.8% women). Baseline variables were common neuropsychological tests (including Mini Mental State Examination-MMSE and Montreal Cognitive Assessment-MoCA), brain CT and 18F-fluorodeoxyglucose (FDG)-PET. Outcome variable was CAD after 1 year.
Results:
At follow-up, 31 (21.7%) patients had CAD. In multivariable analysis (OR, 95% CI), female sex (4.7, 1.6-14.0), MoCA-executive component <3 (6.3, 2.1-19.2), left medial temporal atrophy (MTA) ≥3 (5.4, 1.9-15.7) and FDG-PET suggesting CAD (5.4, 1.9-15.7) were associated with CAD (area under ROC curve 0.873). Without FDG-PET, MMSE score <28 remained associated with CAD (6.0, 2.2-16.9). As first step (before FDG-PET execution), we counted 1 point for MMSE <28, executive MoCA <3 and left MTA ≥3. With 2-3 points CAD probability was high (75%) and with 0 points it was low (6.5%). Thus, FDG-PET (second step) might be performed only in patients with 1 point (probability 19.7%, 42.7% of patients). Among them, 35% had a positive FDG-PET, suggesting high risk. Overall, 28.0% of patients were considered at high risk (specificity 83.9%, sensitivity 71.0%, accuracy 81.1%).
Conclusion:
With a 2-step procedure, less than half of MCI patients might undergo FDG-PET and nearly a quarter of our patients was found to be at high CAD risk, including almost three quarters of future CADs.
Insights
A new two-step method accurately identifies mild cognitive impairment patients at risk of Alzheimer's dementia. This approach reduces the need for costly PET scans, improving early diagnosis and risk stratification for Alzheimer's disease.
Area of Science:
- Neurology
- Neuroimaging
- Cognitive Science
Background:
- Identifying patients with mild cognitive impairment (MCI) at risk of progressing to Alzheimer's dementia (CAD) is crucial for timely intervention.
- Existing methods for risk assessment are often complex, costly, or not readily available in clinical settings.
Purpose of the Study:
- To develop and validate a simple, cost-effective, two-step procedure for identifying MCI patients at high risk of conversion to Alzheimer's dementia.
- To assess the predictive accuracy of combining neuropsychological tests and neuroimaging (FDG-PET) for CAD risk stratification.
Main Methods:
- Retrospective analysis of 143 MCI outpatients, evaluating baseline neuropsychological tests (MMSE, MoCA), brain CT, and 18F-fluorodeoxyglucose (FDG)-PET.
- Outcome variable was conversion to CAD within one year.
- A two-step risk assessment protocol was developed, involving initial screening with MMSE, MoCA executive component, and medial temporal atrophy (MTA) on CT, followed by FDG-PET for intermediate-risk cases.
Main Results:
- At one-year follow-up, 21.7% of patients converted to CAD.
- Multivariable analysis identified female sex, low MoCA-executive score, left MTA, and positive FDG-PET as significant predictors of CAD.
- The proposed two-step procedure achieved high accuracy (81.1%), correctly identifying 71.0% of future CAD cases while maintaining 83.9% specificity, with FDG-PET only being performed on 42.7% of patients.
Conclusions:
- A two-step approach combining basic clinical and imaging data can effectively stratify MCI patients by Alzheimer's dementia risk.
- This method significantly reduces the need for FDG-PET scans, making risk assessment more accessible and cost-effective.
- The strategy successfully identified a high-risk group (28.0% of patients) encompassing a substantial proportion of future CAD cases.
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