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Prediction of Dementia by Subjective Memory Impairment

in
Publisher: 
Archive of General Psychiatry
Author: 
Frank Jessen, MD; Birgitt Wiese, PhD; Cadja Bachmann, MD; Sandra Eifflaender-Gorfer, Dipl-Psych; Franziska Haller, Dipl-Psych; Heike Kölsch, PhD; Tobias Luck, Dipl-Psych; Edelgard Mösch, PhD; Hendrik van den Bussche, MD; Michael Wagner, PhD; Anja Wollny, Dipl-Psych; Thomas Zimmermann, Dipl-Psych; Michael Pentzek, PhD; Steffi G. Riedel-Heller, MD; Heinz-Peter Romberg, MD; Siegfried Weyerer, PhD; Hanna Kaduszkiewicz, MD; Wolfgang Maier, MD; Horst Bickel, PhD; for the German Study on Aging, Cognition and Dementia in Primary Care Patients Study Group
Date published: 
22 April, 2010
Region: 
International

Publication type: 
research
Publication link: 
Prediction of Dementia by Subjective Memory Impairment
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Effects of Severity and Temporal Association With Cognitive Impairment

Context  Subjective memory impairment (SMI) is receiving increasing attention as a pre-mild cognitive impairment (MCI) condition in the course of the clinical manifestation of Alzheimer disease (AD).

Objectives  To determine the risk for conversion to any dementia, dementia in AD, or vascular dementia by SMI, graded by the level of SMI-related worry and by the temporal association of SMI and subsequent MCI.

Design  Longitudinal cohort study with follow-up examinations at 11/2 and 3 years after baseline.

Setting  Primary care medical record registry sample.

Participants  A total of 2415 subjects without cognitive impairment 75 years or older in the German Study on Aging, Cognition and Dementia in Primary Care Patients.

Main Outcome Measures  Conversion to any dementia, dementia in AD, or vascular dementia at follow-up 1 or follow-up 2 predicted by SMI with or without worry at baseline and at follow-up 2 predicted by different courses of SMI at baseline and MCI at follow-up 1.

Results  In the first analysis, SMI with worry at baseline was associated with greatest risk for conversion to any dementia (hazard ratio [HR], 3.53; 95% confidence interval [CI], 2.07-6.03) or dementia in AD (6.54; 2.82-15.20) at follow-up 1 or follow-up 2. The sensitivity was 69.0% and the specificity was 74.3% conversion to dementia in AD. In the second analysis, SMI at baseline and MCI at follow-up 1 were associated with greatest risk for conversion to any dementia (odds ratio [OR], 8.92; 95% CI, 3.69-21.60) or dementia in AD (19.33; 5.29-70.81) at follow-up 2. Furthermore, SMI at baseline and amnestic MCI at follow-up 1 increased the risk for conversion to any dementia (OR, 29.24; 95% CI, 8.75-97.78) or dementia in AD (60.28; 12.23-297.10), with a sensitivity of 66.7% and a specificity of 98.3% for conversion to dementia in AD.

Conclusion  The prediction of dementia in AD by SMI with subsequent amnestic MCI supports the model of a consecutive 3-stage clinical manifestation of AD from SMI via MCI to dementia.

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