New Scoring System Predicts Cognitive Impairment Risk
Researchers at the Mayo Clinic have identified a very simple new scoring system that may be helpful in predicting which elderly patients are at risk of developing mild cognitive impairment, according to a new study in Neurology.
While scientists have identified biomarkers that are promising predictors of Alzheimer’s disease, the expense of such tests makes them unlikely to find widespread use in the primary care clinic, where most people with cognitive symptoms first appear, according to study author Michelle M. Mielke, PhD.
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“The present research suggests that a cost-effective clinical tool, which adds little time to the physician assessment or which can be determined prior to seeing the patient, can be helpful in predicting risk of mild cognitive impairment,” says Mielke, an associate professor of epidemiology and neurology at the Mayo Clinic in Rochester, Minn.
She and her colleagues analyzed data from 1,449 randomly selected study participants from Olmsted County, Minn., who were between the ages of 70 and 89 and did not have any memory or thinking problems.
At the beginning of the study and at visits every 15 months for an average of nearly 5 years, the participants underwent cognitive testing. Over the course of the study, more than a quarter of participants (27.7%) developed mild cognitive impairment.
Based on their data, the researchers developed a scoring system to predict the risk of progressing from cognitive normalcy to mild cognitive impairment. They included factors that health care providers could easily obtain from medical records, such as years of education, number of medications, history of stroke or diabetes, and smoking.
They assigned each factor a score based on how much it contributed to the risk of developing cognitive issues. For example, being diagnosed with diabetes before age 75 increased the risk score by 14 points, while having 12 or fewer years of education increased the risk by just 2 points.
Researchers also factored in information obtained at the clinic visit, such as cognitive testing, symptoms of depression and anxiety, and slow gate.
“Given the ease of the scoring system, particularly the basic model which most physicians should be able to calculate based on medical record information, physicians will have a better assessment of future risk of cognitive impairment,” Mielke says.
This tool may be useful in identifying patients who might benefit from more expensive or invasive diagnostic testing. Given that individuals with mild cognitive impairment are at greater risk of developing dementia, it could also help health care providers to initiate preventive measures sooner.
“Individuals with high risk can be monitored more closely and modifiable risk factors such as diabetes and cardiovascular disease can be monitored and/or treated more aggressively as a means of delaying or preventing cognitive decline,” Mielke says.
She and her colleagues have additional research to do before the scoring system can be integrated in the clinic, particularly validating this risk score in other populations.
“We also want to determine whether other factors, such as neuroimaging, will increase the risk prediction and by how much,” Mielke says. “This might help to determine who would benefit most from undergoing more costly neuroimaging.”
—Colleen Mullarkey
Reference
Pankratz VS, Roberts RO, Mielke MM, Knopman DS, Jack CR, Geda YE, et al. Predicting the risk of mild cognitive impairment in the Mayo Clinic Study of Aging. Neurology. 18 March 2015. [Epub ahead of print].