| 소속 |
Yonsei University College of Medicine, Department of Rehabilitation medicine1, National Health Insurance Service Ilsan Hospital, Department of Rehabilitation Medicine2, National Health Insurance Service Ilsan Hospital, Department of Neurology3, National Health Insurance Service Ilsan Hospital, Research and analysis team4 |
Introduction
By using the grade of long term care service, we can indirectly see the transition from amnestic mild cognitive impairment (aMCI) to dementia. The purpose of the study was to investigate the factors affecting the conversion of aMCI to dementia using data of long term care services and to identify deterioration factors of cognition.
Methods
Based on the Clinical Research Center for Dementia (CRCD) cohort registry from 2005 to 2013, we made a new cohort by merging it with the data from long term care service of National Health Insurance Service(NHIS). We enrolled 3569 patients with aMCI who satisfied the criteria : 1) presence of memory complaints 2) intact function in activities of daily living (ADL); (3) objective cognitive impairment (at least 1.0 standard deviation [SD] below age- and education-adjusted norms) in more than one cognitive domain on standardized neuropsychological testing. All participants completed a complete medical interview, clinical dementia rating (CDR), and brain MRI scan. We obtained information about the age, sex, education, income level, and accompanying diseases (hypertension, diabetes, hyperlipidemia) of the participants. Also, we figured out whether or not patients get were receiving the long-term care service. Transaxial T2 and FLAIRS images of brain were obtained using a 1.5T MRI scanner. We classified the severity of white matter hyperintensity(WMH) change on MRI according to the criteria of Table 1. The patients were classified according to the severity of white matter hyperintensty(WHM) change: aMCI, aMCI with moderate WMH change(aMCI with), aMCI with sever WMH change(svMCI).
Results
Baseline characteristics of the participants are summarized in Table 2. The number of women was about two times higher than that of men, and statistically significant. (p = 0.016). Education period tended to be shorter in the group of severe ischemic change. When comparing the time period of receiving long term care service, hazard ratio of aMCI with was 1.27 based on aMCI, but it was not statistically significant. In the case of svMCI, the time period of receiving long term care service was 1.29 and statistically significant compared with aMCI. (Table 3, Figure1). We sought to determine what factors predicted incident dementia. Severe baseline WMH change, advanced age, female, long educational period, higher CDR scores at baseline significantly predicted dementia in univariate analysis. In multivariate analysis, severe WMH change, advanced age, female and higher CDR scores at baseline significantly predicted progression to dementia
Conclusions
Our findings suggest that severe WMH change, advanced age, female and higher CDR scores at baseline were significant factors that predict progression from MCI to dementia.
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