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Published Online: 20 February 2015

Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Claudia Cooper, Ph.D., M.R.C.Psych., Andrew Sommerlad, M.R.C.Psych., Constantine G. Lyketsos, M.D., M.H.S., and Gill Livingston, M.D., F.R.C.Psych.Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 172, Number 4
https://doi.org/10.1176/appi.ajp.2014.14070878
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Abstract

Objective:

Public health campaigns encouraging early help seeking have increased rates of mild cognitive impairment (MCI) diagnosis in Western countries, but we know little about how to treat or predict dementia outcomes in persons with the condition.

Method:

The authors searched electronic databases and references for longitudinal studies reporting potentially modifiable risk factors for incident dementia after MCI. Two authors independently evaluated study quality using a checklist. Meta-analyses were conducted of three or more studies.

Results:

There were 76 eligible articles. Diabetes and prediabetes increased risk of conversion from amnestic MCI to Alzheimer’s dementia; risk in treated versus untreated diabetes was lower in one study. Diabetes was also associated with increased risk of conversion from any-type or nonamnestic MCI to all-cause dementia. Metabolic syndrome and prediabetes predicted all-cause dementia in people with amnestic and any-type MCI, respectively. Mediterranean diet decreased the risk of conversion to Alzheimer’s dementia. The presence of neuropsychiatric symptoms or lower serum folate levels predicted conversion from any-type MCI to all-cause dementia, but less formal education did not. Depressive symptoms predicted conversion from any-type MCI to all-cause dementia in epidemiological but not clinical studies.

Conclusions:

Diabetes increased the risk of conversion to dementia. Other prognostic factors that are potentially manageable are prediabetes and the metabolic syndrome, neuropsychiatric symptoms, and low dietary folate. Dietary interventions and interventions to reduce neuropsychiatric symptoms, including depression, that increase risk of conversion to dementia may decrease new incidence of dementia.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 172 • Number 4 • April 01, 2015
Pages: 323 - 334
PubMed: 25698435

History

Received: 15 July 2014
Revision received: 4 November 2014
Accepted: 8 November 2014
Published online: 20 February 2015
Published in print: April 01, 2015

Authors

Details

Claudia Cooper, Ph.D., M.R.C.Psych.
From the Division of Psychiatry, University College London; and the Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore.
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Andrew Sommerlad, M.R.C.Psych.
From the Division of Psychiatry, University College London; and the Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore.
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Constantine G. Lyketsos, M.D., M.H.S.
From the Division of Psychiatry, University College London; and the Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore.
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Gill Livingston, M.D., F.R.C.Psych.
From the Division of Psychiatry, University College London; and the Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore.
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Notes

Address correspondence to Dr. Cooper ([email protected]).

Competing Interests

Dr. Lyketsos reports receiving grant support (research or CME) from NIMH, the National Institute on Aging, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, GlaxoSmithKline, Eisai, Pfizer, AstraZeneca, Lilly, Ortho-McNeil, Bristol-Myers Squibb, Novartis, National Football League, Elan, and Functional Neuromodulation; providing consultation or advice to AstraZeneca, GlaxoSmithKline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Pfizer, Genentech, Elan, NFL Players Association, NFL Benefits Office, Avanir, Zinfandel, Bristol-Myers Squibb, Abvie, Janssen, Orion, Otsuka, Servier, and Astellas; and receiving honoraria or travel support from Pfizer, Forest, Glaxo-Smith Kline, and Health Monitor. The other authors report no financial relationships with commercial interests.

Funding Information

Dr. Lyketsos was supported by National Institute on Aging grant P50 AG-005146 to the Johns Hopkins Alzheimer’s Disease Research Center.

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