Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: a 3-year follow-up study

J Am Geriatr Soc. 2006 Apr;54(4):580-6. doi: 10.1111/j.1532-5415.2006.00658.x.


Objectives: To investigate whether mild cognitive impairment (MCI) with multiple impaired cognitive domains (mcd-MCI) is a prodromal manifestation of vascular dementia (VaD).

Design: Prospective cohort study.

Setting: Geriatric unit of the Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.

Participants: Four hundred community-dwelling subjects aged 65 and older who came freely to the geriatric unit as part of a comprehensive geriatric assessment program were evaluated for memory impairment or other cognitive disorders. Subjects with MCI were kept under observation for 3 years.

Measurements: Subjects with MCI were studied by applying a standardized clinical evaluation and a conducting a computed tomography brain scan. Cognitive performance was assessed using the Mini-Mental State Examination, the Clock Drawing Test, and a comprehensive battery of neuropsychological tests. Cardiovascular comorbidity was assessed on the basis of medical history and using electrocardiography, echocardiography, and carotid color Doppler ultrasound.

Results: MCI was found in 65 of the 400 community-dwelling subjects; 31 were classified with amnestic MCI (a-MCI) and 34 with mcd-MCI. A dysexecutive syndrome characterized people with mcd-MCI, who had significantly more vascular comorbidity and signs of vascular disease on brain imaging as well as a higher prevalence of extra pyramidal features, mood disorders, and behavioral symptoms than people with a-MCI. Twenty of the 65 subjects with MCI (31%) progressed to dementia within 3 years of follow-up: 11 subjects with Alzheimer's disease (AD) and nine with VaD. All patients who evolved to AD had been classified with a-MCI at baseline, whereas all patients who evolved to subcortical VaD had been classified with mcd-MCI at baseline.

Conclusion: All subjects who converted to subcortical VaD had been classified with mcd-MCI, suggesting that mcd-MCI might be an early stage of subcortical VaD.

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Cognition Disorders / diagnostic imaging
  • Cognition Disorders / epidemiology*
  • Dementia, Vascular / epidemiology*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Geriatric Assessment
  • Humans
  • Italy / epidemiology
  • Male
  • Neuropsychological Tests
  • Predictive Value of Tests
  • Prevalence
  • Prospective Studies
  • Tomography, X-Ray Computed