Risk of Conversion to Dementia in a Mild Behavioral Impairment Group Compared to a Psychiatric Group and to a Mild Cognitive Impairment Group.

BACKGROUND: There is insufficient available information on behavioral changes in the absence of cognitive impairment as factors increasing the risk of conversion to dementia. OBJECTIVE: To observe and analyze patients with mild behavioral impairment (MBI), mild cognitive impairment (MCI), and a psychiatry group (PG) to compare the risk of progression to dementia. METHODS: From 677 initially assessed ≥60-year-old patients, a series of 348 patients was studied for a five-year period until censoring or conversion to dementia: 96 with MBI, 87 with MCI, and 165 with general psychiatry disorders, including 4 subgroups: Anxiety, Depression, Psychosis and Others. All patients were assessed with clinical, psychiatric, neurological, neuropsychological, and neuroimaging studies. RESULTS: From 348 patients, 126 evolved to dementia (36.2%). Conversion was significantly higher in MBI (71.5%), followed by the MCI-MBI overlap (59.6%) and MCI (37.8%) groups, compared to PG (13.9%) (Log-rank p < 0.001). MCI patients mostly converted to Alzheimer's dementia, while MBI converted to frontotemporal dementia and Lewy body dementia. Patients in PG converted to Lewy body dementia and frontotemporal dementia. CONCLUSION: Conversion to dementia is significantly higher in patients with neuropsychiatric symptoms. The MBI concept generates a new milestone in the refining of diagnosis of neurodegenerative diseases and the possibility of creating neuropsychiatric profiles. Its earlier identification will allow new possibilities for therapeutic intervention.

Role of cognitive reserve in progression from mild cognitive impairment to dementia.

Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies. OBJECTIVES: To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI) to degenerative dementia. METHODS: A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years) was assessed and followed for five years (2001 to 2006). RESULTS: In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer's dementia). Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient) less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion). CONCLUSIONS: MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation), particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.

Reserva cognitiva é a habilidade em otimizar o desempenho através do recrutamento de redes neurais, que talvez reflitam o uso de estratégias cognitivas alternativas. OBJETIVOS: Identificar fatores relacionados à reserva cognitiva associados à progressão do comprometimento cognitivo leve (CCL) para demência degenerativa. MÉTODOS: Uma coorte de 239 indivíduos com CCL (idade: 72.2±8.1anos, 58% mulheres, educação: 12 anos) foram avaliados e seguidos por cinco anos (2001-2006). RESULTADOS: No primeiro ano 13.7% dos CCL converteram para demência e 34.7% em três anos (78.3% converteram para doença de Alzheimer). Os fatores de risco para aqueles que converteram foram: educação menor do que 12 anos, MMSE menor do que 27, teste de Nomeação de Boston menor do que 51, QI (Quociente de Inteligência) menor do que 111, idade superior a 75 anos, falta de ocupação na aposentadoria, e presença de intrusões na memória de evocação (todos contando para 56% da variabilidade de conversão). CONCLUSÕES: Pacientes com CCL são uma população de risco para demência. O estudo dos fatores de risco (como QI, educação e ocupação), principalmente, aqueles relacionados à reserva cognitiva podem contribuir para uma evidência importante para o processo de decisões na atividade clínica e na saúde pública.

Role of cognitive reserve in progression from mild cognitive Impairment to dementia / Papel da reserva cognitiva na progressão de comprometimento cognitivo leve para demência

Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies. Objectives: To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI) to degenerative dementia. Methods: A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years) was assessed and followed for five years (2001 to 2006). Results: In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer dementia). Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient) less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion). Conclusions: MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation), particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.

Reserva cognitiva é a habilidade em otimizar o desempenho através do recrutamento de redes neurais, que talvez reflitam o uso de estratégias cognitivas alternativas. Objetivos: Identificar fatores relacionados à reserva cognitiva associados à progressão do comprometimento cognitivo leve (CCL) para demência degenerativa. Métodos: Uma coorte de 239 indivíduos com CCL (idade: 72.2±8.1 anos, 58% mulheres, educação: 12 anos) foram avaliados e seguidos por cinco anos (2001-2006). Resultados: No primeiro ano 13.7% dos CCL converteram para demência e 34.7% em três anos (78.3% converteram para doença de Alzheimer). Os fatores de risco para aqueles que converteram foram: educação menor do que 12 anos, MMSE menor do que 27, teste de Nomeação de Boston menor do que 51, QI (Quociente de Inteligência) menor do que 111, idade superior a 75 anos, falta de ocupação na aposentadoria, e presença de intrusões na memória de evocação (todos contando para 56% da variabilidade de conversão). Conclusões: Pacientes com CCL são uma população de risco para demência. O estudo dos fatores de risco (como QI, educação e ocupação), principalmente, aqueles relacionados à reserva cognitiva podem contribuir para uma evidência importante para o processo de decisões na atividade clínica e na saúde pública.