The Gothenburg MCI study: Design and distribution of Alzheimer’s disease and subcortical vascular disease diagnoses from baseline to 6-year follow-up

Abstract

There is a need for increased nosological knowledge to enable rational trials in Alzheimer's disease (AD) and related disorders. The ongoing Gothenburg mild cognitive impairment (MCI) study is an attempt to conduct longitudinal indepth phenotyping of patients with different forms and degrees of cognitive impairment using neuropsychological, neuroimaging, and neurochemical tools. Particular attention is paid to the interplay between AD and subcortical vascular disease, the latter representing a disease entity that may cause or contribute to cognitive impairment with an effect size that may be comparable to AD. Of 664 patients enrolled between 1999 and 2013, 195 were diagnosed with subjective cognitive impairment (SCI), 274 with mild cognitive impairment (MCI), and 195 with dementia, at baseline. Of the 195 (29%) patients with dementia at baseline, 81 (42%) had AD, 27 (14%) SVD, 41 (21%) mixed type dementia (¼AD þ SVD ¼ MixD), and 46 (23%) other etiologies. After 6 years, 292 SCI/MCI patients were eligible for followup. Of these 292, 69 (24%) had converted to dementia (29 (42%) AD, 16 (23%) SVD, 15 (22%) MixD, 9 (13%) other etiologies). The study has shown that it is possible to identify not only AD but also incipient and manifest MixD/SVD in a memory clinic setting. These conditions should be taken into account in clinical trials.

High Prevalence of Stress and Low Prevalence of Alzheimer Disease CSF Biomarkers in a Clinical Sample with Subjective Cognitive Impairment

“…The Gothenburg MCI study is an ongoing prospective clinical longitudinal study with a fixed study protocol focusing on the cognitive, neurochemical, brain structural and clinical course of incipient and manifest stages of cognitive disorders such as dementia (see Wallin et al [19] for a full description). Participants undergo biennial comprehensive examinations.…”

“…The procedure for sampling and analysis of CSF has been previously described [19]. A ‘CSF AD profile' was calculated using the formula (Aβ 42 /p-tau > 3.694 + 0.0105 × T-tau) presented by Mattsson et al [30] which has been shown to predict, with good diagnostic accuracy, which MCI patients will progress to AD.…”

Imaging biomarkers of dementia: recommended visual rating scales with teaching cases

“…Vascular dementia is another cause of cognitive impairment, considered to be the second most common form of dementia after Alzheimer’s disease and is observed in about 30 % of all dementia patients. Recently, an overlap between Alzheimer’s disease and vascular dementia with small vessel disease has been reported as a possible contributor and cause of dementia [11–13]. Cerebral amyloid angiopathy and hypertensive arteriopathy constitute the two most common small vessel diseases and are thought to be important parts of the dementia disease process [11, 12].…”

Prognostic Accuracy of Mild Cognitive Impairment Subtypes at Different Cut-Off Levels

“…All participants took part in the Gothenburg MCI study [10]. They had been enrolled in the study if they were between 50 and 79 years of age and if they presented with self-reported and/or informant-reported cognitive decline with a duration of at least 6 months, as assessed in a clinical interview, without obvious relation to somatic or psychiatric disorders or trauma.…”

“…The level of WMC was determined using a modified version of the Fazekas scale [19]. See the publication by Wallin et al [10] for a detailed description of diagnostic procedures.…”