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Neurology 2002;59:198-205
© 2002 American Academy of Neurology

Natural history of mild cognitive impairment in older persons

D. A. Bennett, MD, R. S. Wilson, PhD, J. A. Schneider, MD, D. A. Evans, MD, L. A. Beckett, PhD, N. T. Aggarwal, MD, L. L. Barnes, PhD, J. H. Fox, MD and J. Bach, MSW

From the Rush Alzheimer’s Disease Center and Rush Institute for Healthy Aging (Drs. Bennett, Wilson, Schneider, Evans, Aggarwal, Barnes, Fox, and J. Bach), and Departments of Neurological Sciences (Drs. Bennett, Wilson, Schneider, Evans, Barnes, Aggarwal, and Fox), Pathology (Dr. Schneider), and Internal Medicine (Dr. Evans), Rush–Presbyterian–St. Luke’s Medical Center, Chicago, IL; and Department of Epidemiology and Preventive Medicine (Dr. Beckett), School of Medicine, University of California at Davis.

Address correspondence and reprint requests to Dr. David A. Bennett, Rush Alzheimer’s Disease Center, 1645 W. Jackson, Suite 675, Chicago, IL 60612; e-mail: dbennett{at}rush.edu

Background: Cognitive abilities of older persons range from normal, to mild cognitive impairment, to dementia. Few large longitudinal studies have compared the natural history of mild cognitive impairment with similar persons without cognitive impairment.

Methods: Participants were older Catholic clergy without dementia, 211 with mild cognitive impairment and 587 without cognitive impairment, who underwent annual clinical evaluation for AD and an assessment of different cognitive abilities. Cognitive performance tests were summarized to yield a composite measure of global cognitive function and separate summary measures of episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability. The authors compared the risk of death, risk of incident AD, and rates of change in global cognition and different cognitive domains among persons with mild cognitive impairment to those without cognitive impairment. All models controlled for age, sex, and education.

Results: On average, persons with mild cognitive impairment had significantly lower scores at baseline in all cognitive domains. Over an average of 4.5 years of follow-up, 30% of persons with mild cognitive impairment died, a rate 1.7 times higher than those without cognitive impairment (95% CI, 1.2 to 2.5). In addition, 64 (34%) persons with mild cognitive impairment developed AD, a rate 3.1 times higher than those without cognitive impairment (95% CI, 2.1 to 4.5). Finally, persons with mild cognitive impairment declined significantly faster on measures of episodic memory, semantic memory, and perceptual speed, but not on measures of working memory or visuospatial ability, as compared with persons without cognitive impairment.

Conclusions: Mild cognitive impairment is associated with an increased risk of death and incident AD, and a greater rate of decline in selected cognitive abilities.




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