Reversible Mild Cognitive Impairment: The Role of Comorbidities at Baseline Evaluation

Article type: Research Article

Authors: Grande, Giulia^{a; *} | Cucumo, Valentina^a | Cova, Ilaria^a | Ghiretti, Roberta^a | Maggiore, Laura^a | Lacorte, Eleonora^b | Galimberti, Daniela^c | Scarpini, Elio^c | Clerici, Francesca^{a; 1} | Pomati, Simone^a | Vanacore, Nicola^b | Mariani, Claudio^a

Affiliations: [a] Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, “Luigi Sacco” Hospital, University of Milan, Italy | [b] National Centre of Epidemiology, National Institute of Health, Rome, Italy | [c] Department of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Policlinico, Milan, Italy

Correspondence: [*] Correspondence to: Giulia Grande, Center for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Biomedical and Clinical Sciences, “Luigi Sacco” Hospital, University of Milan, Via G.B. Grassi, 74, I-20157 Milan, Italy. Tel.: +39 02 3904 2761; Fax: +39 02 50319869; E-mail: giulia.grande@unimi.it.

Note: [1] Deceased.

Abstract: The prognostic value of mild cognitive impairment (MCI) is being questioned, with some MCI subjects reverting to normal cognition (NC). The reversion rate varies mostly depending on the study design, the setting, and both MCI and NC definitions. Previous studies have focused on the profile of subjects who revert to NC, but the role of comorbidities has not been entirely investigated. We aimed to evaluate the proportion of MCI subjects who revert to NC in a memory clinic context, focusing on the role of comorbidities. Between 2004 and 2013, 374 MCI subjects were recruited. During a mean time of 32 ± 25.5 months, 21 subjects (5.6%) reverted to NC. Subjects who reverted to NC were younger (p = 0.0001), more educated (p = 0.0001), had a better global cognition (p = 0.0001), as assessed by the Mini-Mental State Examination (MMSE) and suffered from more comorbidities (p = 0.002), as assessed by Cumulative Illness Rating Scale (CIRS) than those who developed dementia. The Cox Regression Model, constructed to adjust for the confounders, showed that the higher were the MMSE (HR = 1.83, CI 95%: 1.07–3.11) and the CIRS score (HR = 1.3, CI 95% 0.88–1.92) at baseline, the higher was the probability of returning to NC than developing dementia, though the last association was not significant. Subjects who reverted to NC were more frequently affected by respiratory (p = 0.002), urologic (p = 0.012), and psychiatric (p = 0.012) diseases. The cognitive performance of subjects with medical comorbidities could benefit from preventive strategies aimed at treating the underlying diseases.

Keywords: Comorbidity, dementia, mild cognitive impairment, prevention

DOI: 10.3233/JAD-150786

Journal: Journal of Alzheimer's Disease, vol. 51, no. 1, pp. 57-67, 2016