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Identifying Amnestic Mild Cognitive Impairment in Primary Care

A Feasibility Study

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Abstract

Background and Objective: Amnestic mild cognitive impairment (aMCI), characterized by episodic memory impairment in the absence of clinical dementia, often represents a transitional stage between normal aging and Alzheimer’s disease (AD). It is not known if non-expert primary-care physicians (PCPs) can differentiate individuals with no cognitive impairment (NCI), aMCI and mild AD in a primary-care practice setting. This study develops an approach to this question, which is necessary for aMCI to become a treatment target.

Methods: Fourteen experts assessed subjects with memory complaints in terms of their laboratory test results, magnetic resonance imaging findings and scores on the Mini-Mental State Examination, adapted Clinical Dementia Rating Scale and Alzheimer’s Disease Assessment Scale-cognitive subscale Delayed Word Recall before designating each subject as having NCI, aMCI or AD. Subjects agreed upon by a consensus committee were assigned to nonexpert PCPs who, following brief training, assessed them using the same clinical information and utilizing the same assessment instruments. The chance-corrected inter-rater reliability (expert versus non-expert) measure κ, based on binary outcome (aMCI/not-aMCI), was estimated.

Results: The study recruited 119 evaluable subjects (50 aMCI, 27 mild AD and 42 NCI) and demonstrated fair to moderate agreement (k = 0.423) between experts and non-experts in designation of aMCI. The percent agreement was 72.3%, sensitivity 62.0% and specificity 79.7%. Overall, non-experts under-rated the level of impairment compared with experts.

Conclusion: This study established the feasibility of making the aMCI designation in the community and identified some likely sources of error. The results suggest that when drugs with clear benefit for aMCI patients are developed, community-based PCPs, with additional, more optimized training, will be able to accurately identify those patients who should receive treatment.

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Acknowledgements

This study was sponsored by Eisai Inc. and Pfizer Inc. Study design, data collection and interpretation of the results were performed by all authors. Dr Doody drafted the manuscript and all authors contributed to critical revisions. Editorial assistance was provided by T. Claus, PhD, at PAREXEL, and was funded by Eisai Inc. and Pfizer Inc.

Drs Doody, Ferris, Salloway and Meuser have received grant funding and honoraria from Pfizer Inc. Dr Murthy is a current employee of Eisai Inc. Drs Goldman and Li are current employees of Pfizer Inc.

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Authors and Affiliations

  1. Alzheimer’s Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA

    Rachelle S. Doody MD, PhD

  2. Alzheimer’s Disease Center, New York University School of Medicine, New York, USA

    Steven H. Ferris

  3. Nathan Kline Institute, Orangeburg, NY, USA

    Steven H. Ferris

  4. Memory and Aging Program, Butler Hospital, Warren Alpert Medical School, Brown University, Providence, RI, USA

    Stephen Salloway

  5. University of Missouri, St Louis, MI, USA

    Thomas M. Meuser

  6. Eisai Inc., Woodcliff Lake, NJ, USA

    Anita K. Murthy

  7. Pfizer Inc, New York, NY, USA

    Chunming Li & Robert Goldman

Authors
  1. Rachelle S. Doody MD, PhD
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  2. Steven H. Ferris
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  3. Stephen Salloway
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  4. Thomas M. Meuser
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  5. Anita K. Murthy
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  6. Chunming Li
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  7. Robert Goldman
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Corresponding author

Correspondence to Rachelle S. Doody MD, PhD.

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Doody, R.S., Ferris, S.H., Salloway, S. et al. Identifying Amnestic Mild Cognitive Impairment in Primary Care. Clin. Drug Investig. 31, 483–491 (2011). https://doi.org/10.2165/11588810-000000000-00000

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  • DOI: https://doi.org/10.2165/11588810-000000000-00000

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