δ Scores Identify Subsets of "Mild Cognitive Impairment" with Variable Conversion Risks

Research output: Contribution to journalArticle

Abstract

Background: The latent variable 'δ' (for 'dementia) is a transdiagnostic measure of dementia severity. δ can be reified and applied to individuals as a composite 'd-score'. Like Spearman's general intelligence factor 'g', δ can be constructed from almost any cognitive battery. So many are available that we must further distinguish each composite as a δ 'homolog'. Fourteen have been validated. All are strongly associated with dementia severity and potentially with mild cognitive impairment (MCI) conversion. Objectives: To assess δ's impact on MCI conversion risk. Methods: A new δ homolog (dDx) was constructed in 1,230 Mexican-American (MA) and 2,215 non-Hispanic White (NHW) participants in the Texas Alzheimer's Research and Care Consortium (TARCC). 1,445 normal controls (NC) and 723 MCI were followed annually for up to 6 years. Results: Each SD decrease in the dDx score increased the risk of conversion sixteen-fold [OR=16.39 (CI: 5.0-52.6)]. Cases below the optimal diagnostic threshold for Alzheimer's disease (AD) versus NC were labeled as having a functionally salient cognitive impairment (FSCI). Such cases were at a 73-fold increase risk of a diagnosis of AD [OR=73.19 (95% CI: 58.3-92.0)]. However, 25.6% of MCI cases were also FSCI(+). They accounted disproportionately for prospective conversions. Age <80 years, the absence of an ϵ4 allele, <12 years of education, and MA ethnicity independently increased the risk of diagnosing FSCI as MCI. Conclusion: A sizable minority of MCI cases may be misdiagnosed and they account disproportionately for AD conversions.

Original languageEnglish (US)
Pages (from-to)199-210
Number of pages12
JournalJournal of Alzheimer's Disease
Volume70
Issue number1
DOIs
StatePublished - Jan 1 2019

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Dementia
Alzheimer Disease
Cognitive Dysfunction
Diagnostic Errors
Intelligence
Alleles
Education
Research

Keywords

  • Aging
  • cognition
  • dementia
  • functional status
  • g
  • intelligence
  • mild cognitive impairment
  • δ

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Psychology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

δ Scores Identify Subsets of "Mild Cognitive Impairment" with Variable Conversion Risks. / Royall, Donald R; Palmer, Ray.

In: Journal of Alzheimer's Disease, Vol. 70, No. 1, 01.01.2019, p. 199-210.

Research output: Contribution to journalArticle

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abstract = "Background: The latent variable 'δ' (for 'dementia) is a transdiagnostic measure of dementia severity. δ can be reified and applied to individuals as a composite 'd-score'. Like Spearman's general intelligence factor 'g', δ can be constructed from almost any cognitive battery. So many are available that we must further distinguish each composite as a δ 'homolog'. Fourteen have been validated. All are strongly associated with dementia severity and potentially with mild cognitive impairment (MCI) conversion. Objectives: To assess δ's impact on MCI conversion risk. Methods: A new δ homolog (dDx) was constructed in 1,230 Mexican-American (MA) and 2,215 non-Hispanic White (NHW) participants in the Texas Alzheimer's Research and Care Consortium (TARCC). 1,445 normal controls (NC) and 723 MCI were followed annually for up to 6 years. Results: Each SD decrease in the dDx score increased the risk of conversion sixteen-fold [OR=16.39 (CI: 5.0-52.6)]. Cases below the optimal diagnostic threshold for Alzheimer's disease (AD) versus NC were labeled as having a functionally salient cognitive impairment (FSCI). Such cases were at a 73-fold increase risk of a diagnosis of AD [OR=73.19 (95{\%} CI: 58.3-92.0)]. However, 25.6{\%} of MCI cases were also FSCI(+). They accounted disproportionately for prospective conversions. Age <80 years, the absence of an ϵ4 allele, <12 years of education, and MA ethnicity independently increased the risk of diagnosing FSCI as MCI. Conclusion: A sizable minority of MCI cases may be misdiagnosed and they account disproportionately for AD conversions.",
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