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Cited by 106Dementia and Cognitive Impairment ResearchCancer-related cognitive impairment studiesHistorical and Modern Theater Studies

Functional and cognitive criteria produce different rates of mild cognitive impairment and conversion to dementia

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Saxton, J, Snitz, B E, Lopez, O L, Ives, D G, Dunn, L O, Fitzpatrick, A, Carlson, M C, DeKosky, S T +1 more·2009·Journal of Neurology, Neurosurgery & Psychiatry
DOI 10.1136/jnnp.2008.160705PMC PMC2698042
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Abstract

OBJECTIVE: To compare rates of mild cognitive impairment (MCI) and rates of progression to dementia using different MCI diagnostic systems. METHODS: MCI was investigated at baseline in 3063 community dwelling non-demented elderly in the Ginkgo Evaluation of Memory (GEM) study who were evaluated every 6 months to identify the presence of dementia. Overall MCI frequency was determined using (1) a Clinical Dementia Rating (CDR) score of 0.5 and (2) neuropsychological (NP) criteria, defined by impairment on standard cognitive tests. RESULTS: 40.2% of participants met CDR MCI criteria and 28.2% met NP MCI criteria (amnestic MCI = 16.6%). 15.7% were classified as MCI by both criteria and 47.4% as normal by both. Discordant diagnoses were observed in 24.5% who met NP normal/CDR MCI and in 12.4% who met NP MCI/CDR normal. Factors associated with CDR MCI among NP normal included lower education, lower NP scores, more instrumental activities of daily living impairment, greater symptoms of depression and subjective health problems. Individuals meeting NP MCI/CDR normal were significantly more likely to develop dementia over the median follow-up of 6.1 years than those meeting NP normal/CDR MCI. CONCLUSIONS: Different criteria produce different MCI rates and different conversion rates to dementia. Although a higher percentage of MCI was identified by CDR than NP, a higher percentage of NP MCI progressed to dementia. These findings suggest that the CDR is sensitive to subtle changes in cognition not identified by the NP algorithm but is also sensitive to demographic and clinical factors probably leading to a greater number of false positives. These results suggest that identifying all individuals with CDR scores of 0.5 as Alzheimer's disease is not advisable.

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  • Saxton et al. showed that a neuropsychological test-based algorithm for MCI diagnosis produced fewer 'false positive' diagnostic errors and provided better prediction of progression than classification based on the CDR.

    “Saxton et al. [22] showed that a neuropsychological test-based algorithm for MCI diagnosis produced fewer ‘false positive’ diagnostic errors and provided better prediction of progression than classification based on the Clinical Dementia Rating (CDR), a structured clinical interview method that stages decline across the spectrum of AD.”

    From Neuropsychological Criteria for Mild Cognitive Impairment Improves Diagnostic Precision, Biomarker Associations, and Progression Rates (2014) · cites this paper as [22]

    The Abstract Conclusions report that a higher percentage of NP-defined MCI cases progressed to dementia and suggest that CDR classification probably produced more false positives. The Discussion calls neuropsychological performance a slightly better indicator of future progression, but the citing sentence presents fewer false-positive errors as an established finding rather than the paper’s qualified inference. (LLM, conf=0.86)

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Authors
Saxton, J., Snitz, B. E., Lopez, O. L., Ives, D. G., Dunn, L. O., Fitzpatrick, A., Carlson, M. C., DeKosky, S. T., & for the GEM Study Investigators
Affiliations
  • University of Pittsburgh (US)
  • University of Washington (US)
  • Johns Hopkins University (US)
  • University of Virginia (US)
Corresponding author
Saxton, J
ORCID
Venue
Journal of Neurology, Neurosurgery & Psychiatry
Publisher
BMJ
Published
2009-03-11
Volume
80
Issue
7
Pages
737-743
ISSN
0022-3050 (ISSN-L)
DOI
10.1136/jnnp.2008.160705
PMC
PMC2698042
OpenAlex
W2142202785
Cited by
106
References
1
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 9 · 2017: 4 · 2016: 7 · 2015: 8 · 2014: 6 · 2013: 8 · 2012: 9
FWCI
7.01
Type
journal article
Language
en
Open access
Locations
  • Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institute on Aging (P50AG005133, P50-AG-05133)
  • National Center for Complementary and Integrative Health (U01AT000162)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
  • Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
Keywords
mild cognitive impairment, conversion to dementia, Clinical Dementia Rating, diagnostic criteria comparison, amnestic MCI, Alzheimer's disease, false positives, dementia risk factors, older adults
MeSH terms
Aged, Aged, 80 and over, Aging, Amnesia, Analysis of Variance, Cognition Disorders, Dementia, Humans, Memory, Neuropsychological Tests, Sensitivity and Specificity, United States, Disease Progression

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