Neuropsychological prediction of conversion to Alzheimer disease in patients with mild cognitive impairment

Context: The likelihood of conversion to Alzheimer disease (AD) in mild cognitive impairment (IMCI) and the optimal early markers of conversion need to be established. Objectives: To evaluate conversion rates to AD in subtypes of MCI and to identify neuropsychological measures most predictive of the time to conversion. Design: Patients were followed up semiannually and controls annually. Subtypes of MCI were determined by using demographically adjusted regression norms on neuropsychological tests. Survival analysis was used to identify the most predictive neuropsychological measures. Setting: Memory disorders clinic. Participants: One hundred forty-eight patients reporting memory problems and 63 group-matched controls. Main Outcome Measure: A consensus diagnosis of probable AD. Results: At baseline, 108 patients met criteria for amnestic MCI: 87 had memory plus other cognitive domain deficits and 21 had pure memory deficits. The mean duration of follow-up for the 148 patients was 46.6 +/- 24.6 months. In 3 years, 32 (50.0%) of 64 amnestic-plus and 2 (10.0%) of 20 pure amnestic patients converted to AD (P=.001). In 148 patients, of 5 a priori predictors, the percent savings from immediate to delayed recall on the Selective Reminding Test and the Wechsler Adult Intelligence Scale-Revised Digit Symbol Test were the strongest predictors of time to conversion. From the entire neuropsychological test battery, a stepwise selection procedure retained 2 measures in the final model: total immediate recall on the Selective Reminding Test (odds ratio per 1-point decrease, 1.10; 95% confidence interval, 1.05-1.14; P <.0001) and Digit Symbol Test coding (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P=.01). The combined predictive accuracy of these 2 measures for conversion by 3 years was 86%. Conclusions: Mild cognitively impaired patients with memory plus other cognitive domain deficits, rather than those with pure amnestic MCI, constituted the high-risk group. Deficits in verbal memory and psychomotor speed/executive function abilities strongly predicted conversion to AD.