Task Switching Performance Reveals Heterogeneity Amongst Patients With Mild Cognitive Impairment

Objective: To assess executive function in patients with mild cognitive impairment (MCI) and to determine whether task switching ability is associated with transition to Alzheimer's disease. Methods: Twenty-seven MCI patients and 19 older controls were tested using a cued letter-digit classification switching task. Sixteen patients could perform the task (MCI-able), 6 could not (MCI-unable), and 5 were able only with cognitive support (MCI-cue). Demographic, neuropsychological, event-related potential (ERP). MRI, and genetic data were also collected. Results: The four groups did not differ on age, gender, and APO E4 frequency. Compared to the controls, the MCI-unable group had significantly poorer performance on the Trail Making task (eta(2) = .430), lower education (eta(2) = .234), and smaller cortical volume (eta(2) = .245). Most MCI patients exhibited task-switching deficits but to vastly different degrees and with varying outcomes. The combined pattern of neuropsychological and task switching performance indicates that the MCI-able patients displayed memory retrieval difficulties (F(2,39) = 3.6, p = .036, MSE = 1.44), generally preserved task switching abilities, and had a high probability of remaining dementia-free at follow-up. The MCI-cue patients had increased mixing costs, F(2,39), = 11.0, p < .001, MSE = .07; the MCI-unable patients showed episodic memory deficits, and both groups had a high probability of poor outcome (i.e., developing AD or dying within four years). Conclusion: This study demonstrates that variability in performance on measures of task-switching can highlight important heterogeneity in the MCI population.