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Conversion to dementia from mild cognitive disorder

The Cache County Study

From the Department of Psychology (J.T.T., M.C.N.), Center for Epidemiologic Studies (J.T.T., C.C., M.C.N., L.T.), Department of Mathematics and Statistics (C.C.), and Department of Family, Consumer and Human Development (M.C.N.), Utah State University, Logan; Department of Psychiatry and Behavioral Sciences (K.A.W.-B.) and Center for the Study of Aging and Human Development (K.A.W.-B., K.H.), Duke University Medical Center, Durham, NC; Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine (C.G.L.), and Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health (P.P.Z., C.G.L.), The Johns Hopkins University, Baltimore, MD; Departments of Neurology, Medicine (Genetics) and Epidemiology (R.C.G.), Boston University Schools of Medicine and Public Health, MA; Department of Epidemiology (N.A.W.), School of Public Health, University of Michigan, Ann Arbor; and VA Puget Sound Health Care System, and Department of Psychiatry and Behavioral Sciences (J.C.S.B.), University of Washington School of Medicine, Seattle.

Address correspondence and reprint requests to Dr. JoAnn T. Tschanz, Associate Professor, Department of Psychology, 4440 Old Main Hill, Logan, UT 84322-4440; e-mail: joannt{at}cc.usu.edu.

Objective: To examine 3-year rates of conversion to dementia, and risk factors for such conversion, in a population-based sample with diverse types of cognitive impairment.

Methods: All elderly (aged 65 or older) residents of Cache County, UT, were invited to undergo two waves of dementia screening and assessment. Three-year follow-up data were available for 120 participants who had some form of mild cognitive impairment at baseline. Of these, 51 had been classified at baseline with prodromal Alzheimer disease (proAD), and 69 with other cognitive syndromes (CS).

Results: Three-year rates of conversion to dementia were 46% among those with cognitive impairment at baseline. By comparison, 3.3% without impairment converted to dementia in the interval. Among converters, AD was the most common type of dementia. In individuals with at least one APOE 4 allele, those with proAD or CS exhibited a 22- to 25-fold higher risk of dementia than cognitively unimpaired individuals (vs 5- to 10-fold higher risk in those without 4).

Conclusions: Individuals with all types of mild cognitive impairment have an elevated risk of dementia over 3 years, more so in those with an APOE 4 allele. These results suggest value in dementia surveillance for broad groups of cognitively impaired individuals beyond any specific category, and utility of APOE genotyping as a prognostic method.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 25 issue to find the title link for this article.

*Other Cache County Study Investigators are listed in the appendix.

Supported by R01-AG11380 (Cache County Study of Memory in Aging) and by R01-AG21136 (Cache Dementia Progression Study).

Presented in preliminary form at the 8th International Conference on Alzheimer’s Disease and Related Disorders and at the 31st Annual Meeting of the International Neuropsychological Society.

Disclosure: The authors report no conflicts of interest.

Received August 29, 2005. Accepted in final form March 21, 2006.

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