Objective: The perspective of an early treatment of dementia raises interest for identifying the transition(mild cognitive impairment: MCI) between normal aging and minimal dementia. Longitudinal studies have shown that dementia may be heralded not only by patient’s complaints and poor performance at memory tasks, but by other deficits related to cognitive skills and emotional-affective control. This suggests the need to ascertain the predictive power of these indicators for progression towards dementia.
Design: In a longitudinal study, we examined the variations in eight cognitive functions measured by the CAMCOG section of the CAMDEX interview to establish which cognitive functions are impaired in individuals converting from MCI to mild dementia.
Materials and Methods: Consecutive series of 74 individuals over 65 years of age admitted to the Geriatric Unit of the Estense Hospital of Modena were administered the CAMDEX interview. In a blind separate evaluation by an expert geriatrician, their cognitive decline was classified as questionable(0.5 score) or mild (1) dementia at the Clinical Dementia Rating Scale (CDR). All patients were followed up after 12 to 18 months.
Results: Patients subdivided into three groups depending on the change in CDR scores: unchanged (54 patients), converted from 0.5 to 1 (10 patients) or from 1 to 2 (10 patients). The variations in global CAMCOG scores obtained at admission and follow-up were significantly different in the 3 groups (F2,73= 15.75, p< .001), with scores in the unchanged group lower than those of the other groups. Moreover, the scores at the follow-up were significantly different for six of the seven cognitive factors of CAMCOG, excluding calculation, and were always higher in the unchanged CDR group with respect to the other two, which differed only for language. The scores across admission and follow-up did not differ significantly for any factors in the unchanged group, whereas they differed for orientation, memory, abstract thinking and perceptual skills in patients converting from 0.5 to 1 at CDR, and for orientation, language, attention, praxis and perceptual skills in patients converting from 1 to 2 at CDR.
Conclusion: The results of this follow-up study suggest impairment of cognitive factors is not homogeneous in patients who convert from 0.5 to 1 and from 1 to 2 within 12 to 18 months, without appreciable deterioration in any factors for patients without conversion. The scores of memory and abstract thinking appear more sensitive to change from 0.5 to 1, whereas language, attention and praxis to change from 1 to 2 at CDR score. Variations of memory and abstract thinking scores in the short term should be considered predictive of conversion from MCI to mild dementia.
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