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Qualitative Estimates of Medial Temporal Atrophy as a Predictor of Progression From Mild Cognitive Impairment to Dementia
Charles DeCarli, MD;
Giovanni B. Frisoni, MD;
Christopher M. Clark, MD;
Danielle Harvey, PhD;
Michael Grundman, MD, MPH;
Ronald C. Petersen, MD, PhD;
Leon J. Thal, MD;
Shelia Jin, MD, MPH;
Clifford R. Jack Jr, MD;
Philip Scheltens, MD, PhD; for the Alzheimer's Disease Cooperative Study Group
Arch Neurol. 2007;64(1):108-115.
Background Individuals diagnosed as having mild cognitive impairment (MCI) have a high likelihood of progressing to dementia within 3 to 5 years, but not all individuals with MCI progress to dementia. Prognostic uncertainty suggests the need for additional measures to assist the clinician.
Objective To assess the added value of qualitative measures of medial temporal atrophy (MTA) to estimate the relative risk of progressing from MCI to dementia.
Design A 3-year, double-blind, placebo-controlled Alzheimer's Disease Cooperative Study initially designed to evaluate the efficacy of donepezil hydrochloride or vitamin E vs placebo to delay progression of MCI to dementia.
Setting Memory assessment centers.
Patients A total of 190 individuals with MCI.
Main Outcome Measures Ratings of MTA performed using magnetic resonance images obtained at baseline. Log-rank tests and Cox proportional hazards ratios examining the significance of MTA estimates in predicting progression of MCI to dementia.
Results A mean MTA score greater than 2.0 was associated with a greater than 2-fold increased likelihood of progression to dementia during the observation period (hazards ratio, 2.30; 95% confidence interval, 1.09-4.92; P = .03) after controlling for age, education, sex, and baseline Mini-Mental State Examination score.
Conclusions Adjusted estimates of MTA were associated with significantly increased risk of developing dementia within 3 years, suggesting that obtaining a magnetic resonance image during the evaluation of MCI may offer additional independent information about the risk of progression to dementia. Given the relatively high prevalence of MCI in the general population, use of this method as part of routine clinical evaluation may help identify individuals who might benefit from increased surveillance and future treatment.
Trial Registration clinicaltrials.gov Identifier: NCT00000173.
Author Affiliations: Department of Neurology and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California at Davis (Dr DeCarli); Laboratory of Epidemiology Neuroimaging and Telemedicine, Istituto di Ricovero e Cura a Carettere Scientifico San Giovanni di Dio Fatebenefratelli, Brescia, Italy (Dr Frisoni); Department of Neurology, Alzheimer's Disease Center, and Institute on Aging, University of Pennsylvania, Philadelphia (Dr Clark); Division of Biostatistics, Department of Public Health Sciences, University of California at Davis (Dr Harvey); Departments of Neurosciences (Drs Grundman and Thal) and Family Preventive Medicine (Dr Jin), University of California at San Diego; Departments of Neurology (Dr Petersen) and Radiology (Dr Jack), Mayo Clinic, Rochester, Minn; and Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands (Dr Scheltens). Dr Grundman is now with the Alzheimer's Disease Program, Elan Pharmaceuticals, San Diego.
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