Risk classification for conversion from mild cognitive impairment to Alzheimer's disease in primary care

There is a pressing need to identify individuals at high risk of conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) based on available repeated cognitive measures in primary care. Using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), we applied a joint latent class mixed model (JLCM) to derive a 3-class solution: low risk (72.65%), medium risk (20.41%) and high risk (6.94%). In the low-risk group, individuals with lower daily activity and ApoE epsilon 4 carriers were at greater risk of conversion from MCI to AD. In the medium-risk group, being female, single, and an ApoE epsilon 4 carrier increased risk of conversion to AD. In the high-risk group, individuals with lower education level and single individuals were at greater risk of conversion to AD. Individual dynamic prediction for conversion from MCI to AD after 10 years was derived. Accurate identification of conversion from MCI to AD contributes to earlier close monitoring, appropriate management, and targeted interventions. Thereby, it can reduce avoidable hospitalizations for the high-risk MCI population. Moreover, it can avoid expensive follow-up tests that may provoke unnecessary anxiety for low-risk individuals and their families.