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Acta Psychiatr Scand 2010: 121: 241242

All rights reserved


DOI: 10.1111/j.1600-0447.2009.01509.x

2010 John Wiley & Sons A/S


ACTA PSYCHIATRICA
SCANDINAVICA

Editorial

Subjective complaints in mild cognitive


impairment make a difference
Mild cognitive impairment (MCI) is an intermediate stage between normal cognitive ageing and
dementia (1). Understanding the incidence of MCI
has important implications for public health planning, development of interventions, and prevention
of the condition. Several studies have reported the
incidence of MCI primarily in population-based
settings (25), but few have reported estimates of
incidence in the clinical setting (6).
In this issue of Acta Psychiatrica Scandinavica,
Luck et al. (7) report estimates of MCI incidence in
a clinical setting. Population-based studies have
reported estimates that range from 21.5 to 76.8 per
1000 person-years (8, 9). The reported MCI incidence of 56.5 per 1000 person-years by Luck et al.
is within this range, but may be lower than would
be expected for the clinical setting (6), possibly
because estimates were derived from family practice rather than from memory clinics where a more
severe spectrum of cognitive impairment would be
present.
The paper by Luck et al. lends support for the
importance of the subjective memory complaint as
an essential element in the criteria for MCI. In their
paper, subjective memory complaints predicted
overall MCI. While some investigators do not
consider subjective memory complaints to be
important (10), this measure may enhance diagnosis in subjects with mild MCI or facilitate detection
of those at increased risk of progression from
normal cognition to MCI. The ndings, therefore,
suggest that subjective memory complaints should
not be taken lightly by providers of health care for
the elderly since it may indeed herald imminent
MCI.
Incidence studies are important for several reasons. They are a reliable estimate of disease frequency and, if the average duration of disease is
relatively stable, may provide more accurate estimates of the prevalence of disease in a community.
This is particularly relevant for MCI; since mild
cases may revert to normal cognition, the estimates
of prevalence may vary in the same population and
across studies. Incidence studies identify causal risk
factors for disease, provide insights into the patho-

physiology of disease, and inform on the design of


interventions and strategies to reduce disease risk
and promote health. The study by Luck et al.
identied older age, vascular conditions, and the
ApoE e4 allele as risk factors for MCI. It also
suggested etiological differences in MCI subtypes.
ApoE e4 allele and older age predicted amnestic
MCI, suggesting an underlying neurodegenerative
aetiology that may be associated with an increased
likelihood of progression to Alzheimers disease. In
contrast, vascular disease, impairment in vision, and
subjective memory complaints were predictive of
non-amnestic MCI, and ApoE e4 had a lesser
impact. Thus, non-amnestic MCI may have a more
heterogeneous aetiology, and may be more likely to
progress to non-Alzheimers disease dementias such
as vascular dementia.
The study by Luck et al. reported a higher
incidence of MCI in men than in women. Other
studies have shown a higher prevalence of MCI in
men than in women (3, 1113). Thus, the study by
Luck et al. suggests that the sex dierence in MCI
prevalence observed in cross-sectional studies may
be valid; however, this remains to be conrmed in
prospective population-based studies of longer
duration.
Despite efforts to standardize the criteria for the
diagnosis of MCI, this issue remains problematic.
Some studies have used a purely algorithmic
approach for a diagnosis of MCI that is based on
neuropsychological testing. Others use a combination that includes information from a clinical
evaluation and psychometric testing. Luck et al.
used the Structured Interview for the Diagnosis of
Dementia of the Alzheimer Type, Multi-Infarct
Dementia, and Dementias of Other Aetiology
cognitive test battery to assess objective cognitive
impairment (14). Although this tool is useful for
assessing dementia, 30 of the 55 questions are the
Mini-Mental State Exam questions; thus, the
battery may have lacked sensitivity for MCI.
Various cutpoints have also been used to assess
impairment in cognitive domains. Use of a cutpoint of 1 standard deviation below the mean of
age- and education-specic norms to determine
241

Editorial
impairment in specic cognitive domains could
have resulted in a lower threshold for impairment.
Limitations of the study include the relatively
short duration of the study (3 years), which raises
questions about the precision of the estimates of
MCI incidence. Due to greater attrition in the early
years of a study and the tendency of some mild
cases of MCI to revert to normal, estimates of
incidence are more stable over a longer duration of
follow-up. The recruitment of participants from
the clinical setting raises questions about the
potential for selection bias among subjects seeking
care; thus, the generalizability of the study ndings
may be limited to studies conducted in a similar
setting. Subjective memory complaints predicted
overall and non-amnestic MCI, but not amnestic
MCI as would have been presumed. This suggests
that subjective memory complaints may encompass
or herald impairment in certain non-memory
cognitive domains.

3.

4.

5.

6.

7.

8.

9.

Acknowledgement
Dr Rosebud O. Roberts is supported by the National Institutes of
Health (NIH) under project number: U01 AG06786, and by the
Robert H. and Clarice Smith and Abigail Van Buren Alzheimers
Disease Research Program. Dr Ronald C. Petersen is supported
by the National Institutes of Health (NIH) under project
numbers: P50 AG016574, AG006786, R01 AG011378, and
U01 AG024904.

Acta Psychiatrica Scandinavica


Rosebud O. Roberts
Ronald C. Petersen
Invited Guest Editors
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