The impact of subtle differences in definitional criteria on conversion rate is highlighted by a report by Morris et al,21 who subdivided CDR=0.5 patients into three groups based on the CDR subscale scores. These groups, defined as (i) uncertain dementia of the Alzheimer type (DAT), (ii) incipient DAT, and (iii) DAT, represented increasing degrees of clinical confidence that prodromal AD was present. Results of survival analyses indicated

that the 5-year rates of progression to dementia (defined as a CDR>1 at follow-up) were 19.9% for the uncertain DAT group, 35.7% for the incipient DAT group, and 60.5% for the DAT group. This Inhibitors,research,lifescience,medical compares with a 5-year rate of progression of 6.8% for controls classified Inhibitors,research,lifescience,medical as having a CDR=0 at baseline. Cross-sectional neurpsychological differences in MCI For a thorough review neuropsychological methods used in MCI see the article by Hahn-Barma et al in this issue.54 A number of studies have compared neuropsychological

test performance in subjects diagnosed as cognitively normal, MCI, and AD. In general, MCI Inhibitors,research,lifescience,medical patients have been found to perform more poorly than normal subjects on a variety of tests that also separate mildly demented patients from normal individuals. Results from several of these studies are summarized in Table I.16,17,21,25,40,55-59 Table I. Studies examining cross-sectional psychometric differences between normal and mild cognitive impairment (MCI) elderly people. GDS, Global Deterioration Scale; CDR, Clinical Dementia Rating; DAT, dementia of the Alzheimer’s type. Updated from reference … While Inhibitors,research,lifescience,medical mean neuropsychologic

test score differences are found to separate groups of normal, MCI, and mild dementia subjects, significant overlap has been noted.25,55 These results highlight the inherent heterogeneity of MCI as a diagnostic entity comprised of both patients with early neurodegenerative disease and more benign forms of ARCD. Interest has therefore Inhibitors,research,lifescience,medical focused on the use of neuropsychological test instruments to predict longitudinal outcome in MCI. Psychometric prediction of dementia in MCI The following review is meant to be representative rather than exhaustive, concentrating on studies that have reported on the predictive accuracies of cognitive/psychometric instruments. A number of studies have assessed longitudinal decline medroxyprogesterone in MCI groups. Rubin et al60 followed 16 individuals with MCI (CDR=0.5) over 7 years and found that 69% had declined to dementia by the end of the third year; no other cases converted beyond that time. No formal neuropsychological test data were reported, but the memory subscale of the CDR at Navitoclax mw baseline predicted 100% of the nondecliners and 64% of the décliners. Similarly, Daly et al43 studied 123 MCI elderly over a 3-year interval and found that 18.7% declined to AD.