Caroli 2007.
| Study characteristics | |||
| Patient sampling |
Primary objectives: to use voxel‐based analysis to find cerebral perfusion correlates of conversion to dementia in people with amnestic MCI Study population: participants with amnestic MCI, either single‐domain or multi‐domain Selection criteria: exclusion criteria: history of depression or psychosis of juvenile onset, clinical major stroke, alcohol abuse, craniocerebral trauma, or heavy use of psychotropic drugs. Participants were included if they agreed to undergo a SPECT‐scan Study design: prospective longitudinal |
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| Patient characteristics and setting |
Clinical presentation: amnestic MCI defined as "complaint of memory or other cognitive disturbances; MMSE: 24‐27/30 or ≥ 28 plus low performance (score of 2/6 or higher) on the clock drawing test; sparing of IADL and ADL or functional impairment due to causes other than cognitive impairment" Age years mean (SD): MCI who progressed to AD (AD): 69 ± 3 years; stable MCI: 71 ± 8 years Gender (% men): MCI who progressed to AD: 56%; stable MCI: 58% Education years mean (SD): MCI who progressed to AD: 11.4 ± 5.7; stable MCI: 8.6 ± 3.6 ApoE4 carriers (%): MCI who progressed to AD: 56%; stable MCI: 43% Neuropsychological tests: MMSE mean (SD): MCI who progressed to AD: 26.8 ± 1.8; stable MCI: 27.0 ± 2.0 Clinical stroke excluded: history or neurological signs of major stroke was a cause of exclusion Co‐morbidities: participants with comorbidities such as hypertension, diabetes and heart disease were included Number enrolled: 56 Number available for analysis: 23 Setting: tertiary psychogeriatrics unit – IRCCS S. Giovanni di Dio‐FBF Brescia, Italy Country: Italy Period of study: April 2002‐March 2005 Language: English |
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| Index tests |
Index test: MRI manual and visual method for estimation of hippocampal volume and medial temporal lobe Manufacturer: Philips Gyroscan Tesla strength: 1.0 Assessment methods: manual segmentation and visual scale (Scheltens 1992). Manual tracings of hippocampal volume was performed using DISPLAY Description of positive case definition by index test as reported: not specified for the manual method; according to Scheltes for the visual method Examiners: no information about radiologist Interobserver variability: not provided |
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| Target condition and reference standard(s) |
Target condition: AD, subcortical VD, LBD, and FTD Prevalence of AD in the sample: 9/23 (39% of cases included in the analysis) Stable MCI or converted to other dementia: 14/23 (61%) stable Reference standard: NINCDS‐ADRDA (McKhann 1984) for AD Mean clinical follow‐up: 1.6 years |
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| Flow and timing |
Withdrawals and losses to follow‐up: 33 MCI. Participants were divided into amnestic (N = 28) and non‐amnestic (N = 28) and only amnestic MCI underwent a yearly follow‐up visit from 1‐3 years after enrolment. 4 amnestic MCI participants refused to have any follow‐up visit and dropped out and 1 participant who converted to FTD was excluded from the analysis. Uninterpretable MRI results were not reported. |
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| Comparative | |||
| Key conclusions by the authors | In conclusion, our results suggest that parahippocampal and inferior temporal hypoperfusion in amnestic MCI patients could be considered as a correlate of conversion to AD. | ||
| Conflict of interests | Not reported | ||
| Notes |
Source of funding: Fondazione Polizzotto (www.fondazionepolizzotto.it) for an unrestricted educational grant 2 x 2 table: data to complete 2 x 2 table provided by the study authors |
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| Methodological quality | |||
| Item | Authors' judgement | Risk of bias | Applicability concerns |
| DOMAIN 1: Patient Selection | |||
| Was a consecutive or random sample of patients enrolled? | No | ||
| Was a case‐control design avoided? | Yes | ||
| Did the study avoid inappropriate exclusions? | No | ||
| High | Low | ||
| DOMAIN 2: Index Test All tests | |||
| Were the index test results interpreted without knowledge of the results of the reference standard? | Unclear | ||
| Did the study provide a clear pre‐specified definition of what was considered to be a "positive" result of the index test? | No | ||
| Was the index test performed by a single operator or interpreted by consensus in a joint session? | Unclear | ||
| High | Low | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Yes | ||
| Were the reference standard results interpreted without knowledge of the results of the index tests? | Yes | ||
| Low | Low | ||
| DOMAIN 4: Flow and Timing | |||
| Was there an appropriate interval between index test and reference standard? | Yes | ||
| Did all patients receive the same reference standard? | Yes | ||
| Were all patients included in the analysis? | No | ||
| High | |||