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Part 2

Oscar L. Lopez, MD; William J. Jagust; Corinne Dulberg, PhD; James T. Becker, PhD; Steven T. DeKosky, MD; Annette Fitzpatrick, PhD; John Breitner, MD; Constantine Lyketsos, MD; Beverly Jones, MD; Claudia Kawas, MD; Michelle Carlson, PhD; Lewis H. Kuller, MD

Arch Neurol. 2003;60:1394-1399.

Objective  To examine the risk factors for mild cognitive impairment (MCI) in a longitudinal population study—the Cardiovascular Health Study Cognition Study.

Design  We examined the factors that in the period 1991 through 1994 predicted the development of MCI in all participants of the Cardiovascular Health Study Cognition Study. Further examination was conducted in the Pittsburgh, Pa, cohort (n = 927), where participants with MCI were classified as having either the MCI amnestic-type or the MCI multiple cognitive deficits–type.

Setting  Multicenter population study.

Patients  This study includes all participants of the Cardiovascular Health Study Cognition Study (n = 3608) who had a magnetic resonance imaging (MRI) scan of the brain between 1991 and 1994, and detailed neuropsychological, neurological, and medical evaluations to identify the presence of MCI or dementia in the period 1998 to 1999. The mean time between the closest clinical examination to the MRI and the diagnostic evaluation for cognitive disorders was 5.8 years for the Cardiovascular Health Study Cognition Study cohort and 6.0 years for the Pittsburgh cohort.

Main Outcome Measures  Risk factors for MCI at the time of the MRI were identified using logistic regression, controlling for age, race, educational level, baseline Modified Mini-Mental State Examination and Digit Symbol Test scores, measurements of depression, MRI findings (atrophy, ventricular volume, white matter lesions, and infarcts), the presence of the apolipoprotein E (APOE) 4 allele, hypertension, diabetes mellitus, and heart disease.

Results  Mild cognitive impairment (n = 577) was associated with race (African American), low educational level, low Modified Mini-Mental State Examination and Digit Symbol Test scores, cortical atrophy, MRI-identified infarcts, and measurements of depression. The MCI amnestic-type was associated with MRI-identified infarcts, the presence of the APOE 4 allele, and low Modified Mini-Mental State Examination scores. The MCI multiple cognitive deficits–type was associated with low Modified Mini-Mental State Examination and Digit Symbol Test scores.

Conclusions  The development of MCI is associated with measurements of cognition and depression, racial and constitutional factors, and cerebrovascular disease. Early cognitive deficits seem to be a common denominator for the 2 forms of MCI; the presence of cerebrovascular disease and the APOE 4 allele is associated with the amnestic type of MCI.

From the Departments of Neurology and Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pa (Drs Lopez, Becker, and DeKosky); Department of Neurology, University of California, Davis, Sacramento (Mr Jagust); Departments of Biostatistics (Dr Dulberg) and Epidemiology (Dr Fitzpatrick), University of Washington, Seattle; Departments of Aging and Health and Mental Hygiene, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (Drs Breitner and Carlson); Departments of Psychiatry (Dr Lyketsos) and Neurology (Dr Kawas), The Johns Hopkins University, Baltimore; Department of Psychiatry, Wake-Forest University, Winston-Salem, NC (Dr Jones); and the Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (Dr Kuller). Dr Breitner is now with the Geriatric Research, Education, and Clinical Center, Veterans Administration Puget Sound Health Care System, Seattle. Dr Kawas is now with the Department of Neurology, University of California, Irvine.

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RELATED LETTER

Hypertension and Mild Cognitive Impairment Subtypes
Francesco Panza, Cristiano Capurso, Alessia D’Introno, Anna M. Colacicco, Andrea Santamato, Antonio Capurso, and Vincenzo Solfrizzi
Arch Neurol. 2008;65(7):992-993.
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Prevalence and Classification of Mild Cognitive Impairment in the Cardiovascular Health Study Cognition Study: Part 1
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Arch Neurol. 2003;60(10):1385-1389.
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