The prognosis of mild cognitive impairment: A systematic review and meta-analysis.

IF 4.4 Q1 CLINICAL NEUROLOGY Alzheimer''s and Dementia: Diagnosis, Assessment and Disease Monitoring Pub Date : 2025-03-12 eCollection Date: 2025-01-01 DOI:10.1002/dad2.70074

Simone Salemme, Flavia Lucia Lombardo, Eleonora Lacorte, Francesco Sciancalepore, Giulia Remoli, Ilaria Bacigalupo, Paola Piscopo, Giovanna Zamboni, Paolo Maria Rossini, Stefano Francesco Cappa, Daniela Perani, Patrizia Spadin, Fabrizio Tagliavini, Nicola Vanacore, Antonio Ancidoni

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Abstract

Introduction: Knowledge gaps remain about the prognosis of mild cognitive impairment (MCI). Conversion rates to dementia vary widely, and reversion to normal cognition has gained attention. This review updates evidence on MCI conversion risk and probability of stability and reversion.

Methods: We searched databases for studies on MCI prognosis with ≥3 years of follow-up, established criteria for MCI and dementia, and performed a meta-analysis using a random-effects model to assess conversion risk, reversion, and stability probability. Meta-regressions identified sources of heterogeneity and guided subgroup analysis.

Results: From 89 studies (mean follow-up: 5.2 years), conversion risk was 41.5% (38.3%-44.7%) in clinical and 27.0% (22.0%-32.0%) in population-based studies, with Alzheimer's dementia as the most common outcome. Stability rates were 49.3% (clinical) and 49.8% (population). Reversion was 8.7% (clinical) and 28.2% (population).

Discussion: Our findings highlight higher conversion in clinical settings and 30% reversion in population studies, calling for sustainable care pathway development.

Highlights: Prognosis for mild cognitive impairment (MCI) varies by setting; dementia risk is higher and the probability of reversion is lower in clinical-based studies.In both clinical and population settings, cognitive stability is ≈50%.A reorganization of health services could ensure sustainable care for individuals with MCI.Significant heterogeneity in MCI studies impacts data interpretation; follow-up length is crucial.Long-term prognosis studies on MCI in low- and middle-income countries are urgently needed.

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轻度认知障碍的预后：一项系统回顾和荟萃分析。

关于轻度认知障碍（MCI）预后的知识差距仍然存在。转化为痴呆症的比率差别很大，恢复到正常认知已经引起了人们的关注。这篇综述更新了MCI转换风险和稳定性和恢复概率的证据。方法：我们检索数据库中随访≥3年的MCI预后研究，建立MCI和痴呆的标准，并使用随机效应模型进行meta分析，评估转换风险、逆转和稳定概率。meta回归确定异质性来源并指导亚组分析。结果：在89项研究中（平均随访5.2年），临床转化风险为41.5%(38.3%-44.7%)，基于人群的研究转化风险为27.0%(22.0%-32.0%)，阿尔茨海默病痴呆是最常见的结局。稳定性分别为49.3%（临床）和49.8%（人群）。复发率为8.7%（临床）和28.2%（人群）。讨论：我们的研究结果强调了临床环境中较高的转换率和人群研究中30%的转换率，呼吁可持续的护理途径发展。重点：轻度认知障碍（MCI）的预后因环境而异；在基于临床的研究中，痴呆的风险较高，而恢复的可能性较低。在临床和人群环境中，认知稳定性为≈50%。卫生服务的重组可以确保对轻度认知障碍患者的持续护理。MCI研究的显著异质性影响数据解释；随访时间长短至关重要。迫切需要对低收入和中等收入国家的轻度认知损伤进行长期预后研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Alzheimer''s and Dementia: Diagnosis, Assessment and Disease Monitoring Medicine-Psychiatry and Mental Health

CiteScore

7.80

自引率

7.50%

发文量

101

审稿时长

8 weeks

期刊介绍： Alzheimer''s & Dementia: Diagnosis, Assessment & Disease Monitoring (DADM) is an open access, peer-reviewed, journal from the Alzheimer''s Association® that will publish new research that reports the discovery, development and validation of instruments, technologies, algorithms, and innovative processes. Papers will cover a range of topics interested in the early and accurate detection of individuals with memory complaints and/or among asymptomatic individuals at elevated risk for various forms of memory disorders. The expectation for published papers will be to translate fundamental knowledge about the neurobiology of the disease into practical reports that describe both the conceptual and methodological aspects of the submitted scientific inquiry. Published topics will explore the development of biomarkers, surrogate markers, and conceptual/methodological challenges. Publication priority will be given to papers that 1) describe putative surrogate markers that accurately track disease progression, 2) biomarkers that fulfill international regulatory requirements, 3) reports from large, well-characterized population-based cohorts that comprise the heterogeneity and diversity of asymptomatic individuals and 4) algorithmic development that considers multi-marker arrays (e.g., integrated-omics, genetics, biofluids, imaging, etc.) and advanced computational analytics and technologies.