Prediction of the Risk of Conversion from Mild Cognitive Impairment to Alzheimer`S Disease Dementia
Gisele Santos Gonçalves
Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha Campus, Belo Horizonte, Minas Gerais, 31270 90, Brazil.
Lucas Ferreira Alves *
Pontifical Catholic University of Minas Gerais, Coração Eucarístico Campus, Rua Dom José Gaspar, 500, Coração Eucarístico Campus, Belo Horizonte, Minas Gerais, 30535 901, Brazil.
Maria Aparecida Camargos Bicalho
Faculty of Medicine, Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130 100 Brazil.
Caio Coelho Moreira
Department of Statistics, Federal University of Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha Campus, Belo Horizonte, Minas Gerais , 31270 901, Brazil.
Edna Afonso Reis
Department of Statistics, Federal University of Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha Campus, Belo Horizonte, Minas Gerais , 31270 901, Brazil.
Ieda de Fátima Oliveira Silva
Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha Campus, Belo Horizonte, Minas Gerais, 31270 90, Brazil.
Maria das Graças Carvalho
Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antônio Carlos, 6627, Pampulha Campus, Belo Horizonte, Minas Gerais, 31270 90, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Purpose: Identification of individuals at high risk of progressive cognitive deterioration may be useful for prognosis and intervention. The present investigation addressed the development of an algorithm for predicting the risk of conversion from mild cognitive impairment (MCI) to Alzheimer’s disease (AD) based on clinical, sociodemographic and laboratory data over a three-year clinical follow-up.
Methods: Thirty-eight elderly patients of both sexes, diagnosed with MCI, participated in the present study. A total of 72 variables including inflammatory, hemostatic and vascular parameters, in addition to clinical, sociodemographic and cognitive evolution data of the patients were used in the construction of an algorithm to estimate the probability of an individual evolving from MCI to AD within a three-year period.
Results: Age, gender, peak of thrombin generation test in the presence of activated protein C (TG peak+aPC) and homocysteine were the variables found independently associated with the highest risk of conversion from MCI to AD, that is, male patients aged ≥ 80 years old, TG peak+aPC ≥58nM and homocysteine levels ≥ 30 µmol/L.
Conclusion: Based on the results presented here, we propose that elderly patients, mainly males, should have their serum homocysteine levels and hemostatic status constantly monitored and, in cases of hyperhomocysteinemia and hypercoagulability, control measures should be taken immediately, provided that these changes are potentially modifiable. We suggest that the adoption of measures to control these undesirable conditions may reduce the chances of patients evolving from MCI to AD.
Keywords: Alzheimer disease, mild cognitive impairment, algorithm, homocysteine, thrombin generation test