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Sarah Tomaszewski Farias, PhD; Dan Mungas, PhD; Bruce R. Reed, PhD; Danielle Harvey, PhD; Charles DeCarli, MD

Arch Neurol. 2009;66(9):1151-1157.

Background  Mild cognitive impairment is increasingly recognized as an important public health problem associated with increased risk of developing dementia. Annual conversion rates, however, vary across different studies with clinic samples showing higher rates of conversion than community-based samples.

Objectives  To establish whether the rates of conversion from mild cognitive impairment to dementia differed according to recruitment source and, if so, to investigate factors that might explain this discrepancy.

Design  Rates and predictors of conversion were examined in a prospective longitudinal study at a single center.

Setting  Among the participants, 46% were recruited from a clinical setting and 54% were recruited directly through community outreach.

Participants  One hundred eleven individuals with mild cognitive impairment were followed up longitudinally for an average of 2.4 years (range, 0.5-4.0 years).

Main Outcome Measures  Conversion from mild cognitive impairment to dementia.

Results  During the follow-up period, 28 individuals progressed to dementia with a mean (SD) time to conversion of 2.19 (0.72) years. The clinic sample had an annual conversion rate of 13%, whereas the community sample had an annual conversion rate of 3%. In a Cox proportional hazards model, clinic recruitment source alone was associated with an increased hazard of incident dementia (hazard ratio = 3.50; 95% confidence interval, 1.31-9.18; P = .01). When other variables were added to the model, only baseline functional impairment as measured by the Clinical Dementia Rating Scale (and no demographic, cognitive, or neuroimaging variables or mild cognitive impairment subtype) accounted for the differences in conversion rates across the 2 cohorts.

Conclusions  These findings add to the growing literature to suggest that the degree of functional impairment at baseline is an important predictor of conversion to dementia and may help explain differences in findings between epidemiological and clinic-based studies.

Author Affiliations: Departments of Neurology (Drs Farias, Mungas, Reed, and DeCarli) and Public Health Sciences (Dr Harvey), University of California, Davis; and Veterans Affairs Northern California Health Care System, Mather (Dr Reed).

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