Fluctuating Cognitive Impairment and Dementia Risk

MedicalResearch.com Interview with:
Dr. Alan B. Zonderman PhD
Cognition Section
Laboratory of Personality and Cognition, NIA
Gerontology Research Center
Baltimore, MD 21224-6825

MedicalResearch.com: What are the main findings of the study?

Dr. Zonderman: In a prospective population-based 5-year follow-up study the authors examined the rate at which participants converted from mild cognitive impairment to dementia or reverted from mild cognitive impairment to normal cognitive performance.  As has been common, they found elevated risk for dementia associated with mild cognitive impairment, but also found elevated risk for dementia among those who reverted (temporarily) to normal cognitive performance.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Zonderman: Until these data it’s been unclear whether changes in status were due to inconsistent diagnostic procedures or whether they were true changes in cognitive performance.  Additionally, the clinical significance of such intra-individual variations was unclear if these changes were not just unreliability in diagnostic procedures.  What was surprising was that the risk for dementia was so large (hazard ratio = 6.6) that the effect is unlikely to have been just a trivial finding.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Zonderman: These results suggest that although the time course of dementia is usually unpredictable for any individual, a temporary reversion from mild cognitive impairment to unimpaired cognitive performance is unlikely to signal the absence of the disease.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Zonderman: Although the authors suggest that individuals who revert from mild cognitive impairment are candidates for intervention trials, we should temper this by the likelihood that such individuals may already have the disease. It is most likely that only the manifestation of the disease reverted, probably not the underlying brain pathology.  This suggests that we should begin studies of dementia before any manifestation of the disease occurs.

Individuals who revert to unimpaired cognitive performance from mild cognitive impairment may be candidates for treatment interventions that might delay reversion to dementia.  Such interventions might include pharmacological therapeutics, but may also include other treatments such as physical exercise.

Citation:

Risk of dementia after fluctuating mild cognitive impairment:
When the yo-yoing stops
Alan B. Zonderman, PhD and; Gregory A. Dore, PhD.
Journal Neurology
Published ahead of print: December 18 2013

 

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