1. MCI Conversion to Dementia: Clinic and Community-Based Studies
Ranjan Duara, M.D.
Wien Center for Alzheimer’s Disease & Memory Disorders, Miami Beach

2. Collaborators Wien Center, Mount Sinai, Miami Beach
Ranjan Duara, MD, David Loewenstein, PhD
Amarilis Acevedo, PhD, Warren Barker, MS
Debbie Hurwitz, MSW, Marina Bravo, MSW
Mercy Luis, MSW, Cheryl Luis, PhD
Roskamp Institute, USF, Tampa
Michael Mullan, MD, PhD, Fiona Crawford, PhD
University of Toronto
Peter St. George-Hyslop, MD

3. MCI to Dementia Conversion Demographics of Clinic Sample
MCI With Followup (n)
210
Age of Onset (yrs)
72  9
MMSE
25  3
Diagnosis (% AD)
59%
Followup Interval (yrs)
1.9  1.8
Followup Rate (%)
25.5%

4. MCI Study: Non-AD Diagnoses
Diagnosis
Number / %
Vascular Cognitive Impairment
32 / 37%
Psychiatric Disorders (depression, etc)
11 / 13%
Other Degenerative
(FTD, Parkinsons, etc)
8 / 9%
Other Neurological
(seizure, hydrocephalus, etc.)
35 / 41%

5. Criteria for MCI
History of cognitive impairment (subjective, collateral, or both)
Objective cognitive deficits on memory  other cognitive domains
Lacking DSM III criteria for dementia
Preserved functional capacity

6. Criteria for MCI (AD) Meets criteria for MCI
Meeting NINCDS-ADRDA criteria for AD, but lacking DSM III criteria for dementia

7. Criteria for Conversion of MCI to Dementia in Clinic Sample
Worsening of cognitive function by collateral report
Worsening of objective cognitive deficits
Meets DSM III criteria for dementia

8. APOE e4 Allele Frequency in Clinic Samples
Diagnosis
e4 Frequency (%)
Probable AD (n=678)
29%
MCI – AD (n=195)
26%
MCI – Other (n=138)
14%

9. Conversion to Dementia Effect of AD Diagnosis
2=6.8 (p=.009)

10. MCI to Dementia Conversion Rates in Clinic Sample
1-yr Rate
2-yr Rate
3-yr Rate
ALL MCI
(n=210)
17%
31%
47%
MCI - AD
(n=124)
23%
41%
58%
MCI - Non-AD (n=86)
11%
21%
34%
2=6.8 (p=.009) for survival curve difference of AD vs non-AD

11. Conversion to Dementia Effect of APOE

12. Conversion to Dementia Effect of Age
2=0.4 (p=.83)

13. Factors Influencing Follow-Up Rate in MCI Patients
Predictor
Data
P-value
Gender
26% (m) 23%(f)
n.s.
AD Diagnosis
32%(MCI-AD)
20% (MCI-non-AD)
.006
Age at Onset of MCI
24% (60s) 29% (70s)
21% (80+)
.16
Initial MMSE
24.4 (followup+)
24.9 (no followup)
Initial HDRS (fup+/-)
8.4 (followup+)
8.7 (followup-)

14. MCI to Dementia Risk Factors in Clinic Sample
No Association
Age of onset
Use of Aricept
Education
Gender
Increased Risk
Diagnosis of AD
APOE e4 (trend)

15. Classification of Screening Sample
MMSE
(0-30)
4 Trial Recall (0-12)
APOE e4 Allele Frequency
Normal
24
10
12%
MCI
<24
5-9
>4
18%
Demented 4
26%

16. MCI to Dementia Conversion
11%
15%
20%