MCI-to-normal reversion using neuropsychological criteria in the Alzheimer's Disease Neuroimaging Initiative

Abstract

Introduction: The low mild cognitive impairment (MCI) to cognitively normal (CN) reversion rate in the Alzheimer's Disease Neuroimaging Initiative (2-3%) suggests the need to examine reversion by other means. We applied comprehensive neuropsychological criteria (NP criteria) to determine the resulting MCI to CN reversion rate.

Methods: Participants with CN (n = 641) or MCI (n = 569) were classified at baseline and year 1 using NP criteria. Demographic, neuropsychological, and Alzheimer's disease biomarker variables as well as progression to dementia were examined across stable CN, reversion, and stable MCI groups.

Results: NP criteria produced a one-year reversion rate of 15.8%. Reverters had demographics, Alzheimer's disease biomarkers, and risk-of-progression most similar to the stable CN group and showed the most improvement on neuropsychological measures from baseline to year 1.

Discussion: NP criteria produced a reversion rate that is consistent with, albeit modestly improved from, reversion rates in meta-analyses. Reverters' biomarker profiles and progression rates suggest that NP criteria accurately tracked with underlying pathophysiologic status.

Keywords: Alzheimer's disease; Diagnostic criteria; Mild cognitive impairment; Neuropsychology; Reversion; Stability.

Copyright © 2019 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. Baseline to Year 1 change in neuropsychological scores by group.

Error bars represent the 99% confidence interval. MMSE=Mini Mental State Exam; AVLT=Rey Auditory Verbal Learning Test; BNT=Boston Naming Test (30-item); TMT=Trail Making Test. For TMT Parts A and B, lower scores represent better (faster) performance. Raw scores have been adjusted for age, sex, and education.

Figure 2

Kaplan-Meier curves for Stable CN, Reversion, and Stable MCI group rates of progression to dementia.