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*For medical professionals only
Mild cognitive impairment (MCI) before progression to dementia is often overlooked
.
Studies believe that MCI is a transitional state
in the progression of normal aging to dementia.
To accommodate heterogeneity in etiology and prognosis, MCI is divided into multiple subtypes [1].
Amnestic mild cognitive impairment (aMCI), the most common subtype of MCI, involves episodic memory loss, and is more likely to progress to classic AD; Nonamnesic MCI (naMCI) involves impairment in cognitive domains other than memory and progresses more often to atypical AD and other types of dementia [2-3].
Most epidemiological studies of MCI and its subtypes in China target the urban population, rarely pay attention to rural residents, and the diagnosis of MCI in the study only uses simple cognitive screening tests
.
In order to study the prevalence of MCI and its main subtypes among the elderly in rural communities in China, the team of Du Yifeng and Qiu Chengxuan of the Affiliated Provincial Hospital of Shandong First Medical University (Shandong Provincial Hospital) conducted a single-center study
based on rural communities.
This is reportedly the largest single-center study to date! The research was published in Alzheimer's Disease and Dementia
.
The study showed that the prevalence of MCI in rural older people over 60 years old in China is more than a quarter
.
Among them, the prevalence of MCI in women was higher than that in men.
Older age, low level of education and farmers are associated with an increased risk of MCI and its subtypes; In addition, the risk of MCI is associated with a variety of factors, including alcohol consumption, smoking, and stroke history, but not with apolipoprotein E (APOE) genotype and cardiometabolic factors [4].
Screenshot of the first page of the paper
This community-based cross-sectional study analyzed data
from participants in the Dementia Multimodal Intervention Program (MIND-China) in China.
Of the 7698 eligible participants (age ≥60 years), 1933 participants were excluded due to death (n = 128), refusal (n = 1200), inability to contact (n = 569), and severe mental illness (n = 36
).
Of the remaining 5765 participants who underwent baseline testing (74.
9% of all eligible participants), the researchers further excluded participants with dementia (n=307) and those with missing or insufficient information to diagnose MCI (n=390
).
In the end, the study included a total of 5068 participants
.
Research Flow Chart (MIND-China, Multimodal Interventions to Delay Dementia and Disability in Rural China)
At the beginning of the study, the researchers collected the participants' sociodemographic characteristics, lifestyle habits, and medical history
.
The results showed that the average age of the participants was 70.
17 years old (SD 5.
23), 56.
45% of all participants were female, 37.
12% were illiterate, 82.
48% were farmers, and 15.
87% carried the APOE ε4 allele
.
Next, the researchers performed a neurological examination of the participants to assess their motor and sensory function, cranial nerve status, and reflexes
.
At the same time, participants were assessed for depressive symptoms
using the 15-item Geriatric Depression Scale (GDS-15).
The results showed that among the participants ≥ 60 years old, a total of 1342 people had MCI, with a crude prevalence of 26.
48%.
Among them, 1130 were aMCI, and the crude prevalence rate was 22.
30%; 212 were naMCI, with a crude prevalence of 4.
18
%.
19 Listen to Marwan Noor Sabag, Director of Translational Research at the Lou Ruvo Center for Brain Health at the Cleveland Clinic, interpret Down syndrome and Alzheimer's disease
In participants ≥ 65 years of age, the crude prevalence of MCI was 27.
25%; The crude prevalence of aMCI was 23.
05%; The crude prevalence of naMCI was 4.
20%.
The researchers' analysis found that about a quarter of the participants had MCI, and aMCI patients accounted for 84.
20% of all MCI patients; Compared with men, the crude prevalence of MCI (30.
90% vs 20.
75%, P<0.
001), aMCI (25.
52% vs 18.
12%, P<0.
001), and naMCI (5.
38% vs 2.
63%, P<0.
001) was higher<b10>.
Crude and standardized prevalence of MCI and its subtypes (per 100 population) among all participants
The researchers also found that the prevalence of MCI increased with age, from 19.
44% in 60-64 years to 40.
00% in ≥80 years; The prevalence was higher in women than in men
in participants of all age groups.
Age- and sex-specific prevalence trends in aMCI are similar to those in MCI, but age-specific trends and sex differences in the prevalence of naMCI are less pronounced
.
Age- and sex-specific prevalence of MCI (A), aMCI (B), and naMCI (C) (per 100 population)
After adjusting for age, education, clinical situation, and APOE genotype, there were no significant sex differences
in the overall prevalence of MCI, aMCI, and naMCI.
Higher educational attainment was significantly associated with a lower likelihood of having MCI, aMCI, and naMCI, with participants with primary school diploma and lower secondary school and above having a reduced risk of MCI by 29% (OR 0.
71, 95% CI 0.
61-0.
82) and 70% (0.
30, 0.
24-0.
39)
respectively compared with illiterate participants.
Farmers were significantly associated with
an increased likelihood of having MCI, aMCI, and naMCI.
A history of hypertension and stroke was significantly associated with an increased likelihood of having naMCI, but not with
aMCI.
Diabetes, hyperlipidemia, ischemic heart disease, heart failure, atrial fibrillation, and APOE ε4 alleles were not significantly associated
with the overall prevalence of MCI, aMCI, and naMCI.
More specifically, alcohol consumption was associated with a reduced likelihood of having MCI and aMCI, but not
with naMCI.
However, the researchers proposed that the relationship between alcohol consumption and cognitive impairment is complex, depending on the amount of alcohol consumed and the quantitative method of drinking, and past studies have given inconsistent results, and the results on MCI subtypes have been rarely reported, and further exploration of the relationship
between alcohol consumption and MCI and different subtypes in the future needs to be further explored.
Odds ratio (OR) of MCI(A), aMCI(B), and naMCI(C) related to various factors
Overall, the results of this largest single-center study contribute to a certain extent to further understanding and understanding of MCI, and may provide clinicians with some guidance in early recognition and early intervention of MCI
.
The main strength of the study was the inclusion of a large community sample of older adults in rural China and the combination of neuropsychological assessment with face-to-face clinical assessment to provide them with a comprehensive cognitive assessment
.
It is believed that future follow-up data will help elucidate the incidence of MCI and its subtypes among the elderly in rural China, and identify demographic, genetic and modifiable factors
from normal cognition to MCI to dementia.
References:
1.
Petersen RC, Caracciolo B, Brayne C, Gauthier S, Jelic V, Fratiglioni L.
Mild cognitive impairment: a concept in evolution.
J Intern Med.
2014; 275(3):214-228.
2.
Knopman DS, Amieva H, Petersen RC, et al.
Alzheimer disease.
Nat Rev Dis Primers.
2021; 7(1):33.
3.
Ferman TJ, Smith GE, Kantarci K, et al.
Nonamnestic mild cognitive impairment progresses to dementia with Lewy bodies.
Neurology.
2013; 81(23):2032-2038.
4.
Cong L, Ren Y, Wang Y, et al.
Mild cognitive impairment among rural-dwelling older adults in China: A community-based study.
Alzheimers Dement.
2022; 10.
1002/alz.
12629.
Responsible editorYing Yuyan
