Determinants, MRI Correlates, and Prognosis of Mild Cognitive Impairment: The Rotterdam Study

Issue title: 2013 International Congress on Vascular Dementia

Guest editors: Amos D. Korczyn

Article type: Research Article

Authors: de Bruijn, Renée F.A.G.^{a; b; 1} | Akoudad, Saloua^{a; b; c; 1} | Cremers, Lotte G.M.^{a; c; 1} | Hofman, Albert^a | Niessen, Wiro J.^{c; d} | van der Lugt, Aad^c | Koudstaal, Peter J.^b | Vernooij, Meike W.^{a; c} | Ikram, M. Arfan^{a; b; c; *}

Affiliations: [a] Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands | [b] Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands | [c] Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands | [d] Imaging Science and Technology, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands

Correspondence: [*] Correspondence to: Dr. M. Arfan Ikram, Erasmus University Medical Center, Office secretariat Epidemiology: Na 28-18, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. Tel.: +31 10 7043930; E-mail: [email protected].

Note: [1] These authors contributed equally to this work.

Abstract: Mild cognitive impairment (MCI) marks a transitional stage between healthy aging and dementia, but the understanding of MCI in the general population remains limited. We investigated determinants, MRI-correlates, and prognosis of MCI within the population-based Rotterdam Study. Firstly, we studied age, APOE-ε4 carriership, waist circumference, hypertension, diabetes mellitus, total and HDL-cholesterol levels, smoking, and stroke as potential determinants of MCI. Determinants were assessed cross-sectionally at baseline (2002–2005) and up to 7 years prior to baseline (1997–2001). Secondly, we compared volumetric, microstructural, and focal MRI-correlates in persons with and without MCI. Thirdly, we followed participants for incident dementia and mortality until 2012. Out of 4,198 participants, 417 had MCI, of whom 163 amnestic and 254 non-amnestic MCI. At baseline, older age, APOE-ε4 carriership, lower total cholesterol levels, and stroke were associated with MCI. Additionally, lower HDL-cholesterol levels and smoking were related to MCI when assessed 7 years prior to baseline. Persons with MCI, particularly those with non-amnestic MCI, had larger white matter lesion volumes, worse microstructural integrity of normal-appearing white matter, and a higher prevalence of lacunes, compared to cognitively healthy participants. MCI was associated with an increased risk of dementia (hazard ratio (HR) 3.98, 95% confidence interval (CI) 2.97;5.33), Alzheimer's disease (HR 4.03, 95% CI 2.92;5.56), and mortality (HR 1.54, 95% CI 1.28;1.85). In conclusion, we found that several vascular risk factors and MRI-correlates of cerebrovascular disease were related to MCI in the general population. Participants with MCI had an increased risk of dementia, including Alzheimer's disease, and mortality.

Keywords: Dementia, determinants, epidemiology, magnetic resonance imaging, mild cognitive impairment, mortality, population-based, prognosis

DOI: 10.3233/JAD-132558

Journal: Journal of Alzheimer's Disease, vol. 42, no. s3, pp. S239-S249, 2014