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Special Article |

Revised Criteria for Mild Cognitive Impairment May Compromise the Diagnosis of Alzheimer Disease Dementia

John C. Morris, MD
Arch Neurol. 2012;69(6):700-708. doi:10.1001/archneurol.2011.3152.
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Published online

Objective To evaluate the potential impact of revised criteria for mild cognitive impairment (MCI), developed by a work group sponsored by the National Institute on Aging and the Alzheimer's Association, on the diagnosis of very mild and mild Alzheimer disease (AD) dementia.

Design Retrospective review of ratings of functional impairment across diagnostic categories.

Setting Alzheimer's Disease Centers and the National Alzheimer's Coordinating Center.

Participants Individuals (N = 17 535) with normal cognition, MCI, or AD dementia.

Main Outcome Measures The functional ratings of individuals with normal cognition, MCI, or AD dementia who were evaluated at Alzheimer's Disease Centers and submitted to the National Alzheimer's Coordinating Center were assessed in accordance with the definition of “functional independence” allowed by the revised criteria. Pairwise demographic differences between the 3 diagnostic groups were tested using t tests for continuous variables and χ2 for categorical variables.

Results Almost all (99.8%) individuals currently diagnosed with very mild AD dementia and the large majority (92.7%) of those diagnosed with mild AD dementia could be reclassified as having MCI with the revised criteria, based on their level of impairment in the Clinical Dementia Rating domains for performance of instrumental activities of daily living in the community and at home. Large percentages of these individuals with AD dementia also meet the revised “functional independence” criterion for MCI as measured by the Functional Assessment Questionnaire.

Conclusions The categorical distinction between MCI and milder stages of AD dementia has been compromised by the revised criteria. The resulting diagnostic overlap supports the premise that “MCI due to AD” represents the earliest symptomatic stage of AD.

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Figure 1. Percentage of participants with Alzheimer disease (AD) dementia in the National Alzheimer's Coordinating Center who would be considered “independent in functional activities” by revised mild cognitive impairment criteria where “independent” includes Clinical Dementia Rating (CDR) box scores of 0, 0.5, and 1. These individuals could thus be reclassified as having mild cognitive impairment.

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Figure 2. Percentage of participants with Alzheimer disease (AD) dementia in the National Alzheimer's Coordinating Center who would be considered “independent in functional activities” by revised mild cognitive impairment criteria where “independent” includes Clinical Dementia Rating (CDR) box scores of 0 and 0.5. These individuals could thus be reclassified as having mild cognitive impairment.

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Figure 3. Percentage of participants with Alzheimer disease (AD) dementia in the National Alzheimer's Coordinating Center who would be considered “independent in functional activities” by revised mild cognitive impairment criteria where “independent” includes “does with assistance” (Functional Assessment Questionnaire score = 0, 1, and 2). These individuals could thus be reclassified as having mild cognitive impairment. CDR indicates Clinical Dementia Rating.

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Figure 4. Percentage of participants with Alzheimer disease (AD) dementia in the National Alzheimer's Coordinating Center who would be considered “independent in functional activities” by revised mild cognitive impairment criteria where “independent” includes “does by self with difficulty” (Functional Assessment Questionnaire score = 0 and 1). These individuals could thus be reclassified as having mild cognitive impairment. CDR indicates Clinical Dementia Rating.

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