Cognitive trajectories modeling of rare reversion in mild cognitive impairment
10.12173/j.issn.1005-0698.202503205
- VernacularTitle:轻度认知障碍罕见逆转的认知轨迹建模
- Author:
Yao QIN
1
;
Yanji HUO
;
Jing ZHOU
;
Yan ZHOU
;
Hongjuan HAN
;
Jing CUI
;
Hongmei YU
Author Information
1. 山西医科大学公共卫生学院卫生统计学教研室(太原 030001);重大疾病风险评估山西省重点实验室(太原 030001);煤炭环境致病与防治教育部重点实验室(太原 030001)
- Publication Type:Journal Article
- Keywords:
Mild cognitive impairment;
Reversion;
Rare events;
Functional principal component analysis;
Multi-state model
- From:
Chinese Journal of Pharmacoepidemiology
2025;34(8):877-886
- CountryChina
- Language:Chinese
-
Abstract:
Objective To construct a dynamic framework for bidirectional transitions of mild cognitive impairment(MCI),quantifying both rare reversion and high-risk progression trajectories in cognitive dynamics.Methods Patients diagnosed with MCI at baseline from 2005 to 2022 and completed at least two follow-up visits were selected from the Alzheimer's Disease Neuroimaging Initiative(ADNI),and a retrospective cohort was constructed.Demographic information,APOEε4 genotype,and neuropsychological scales data were collected.Longitudinal cognitive assessments were functionally reconstructed using multivariate functional principal component analysis(MFPCA),with functional principal components(FPCs)extracted based on cumulative variance contribution rate(PVE＞90％).Functional multi-state Markov models were developed to estimate inter-state transition intensities,year to year transition probabilities,and covariate effects.Results Among 1,019 MCI patients(4,657 follow-up visits),93(9.1％)reverted to normal cognition,while 359(35.2％)progressed to Alzheimer's disease(AD).Longitudinal trajectory analysis revealed significant heterogeneity:progressive MCI＞stable MCI＞reverted MCI in the first functional principal component(MFPC1)scores.The transition intensity for MCI reversion(0.020)was approximately one-fourth of the AD progression risk(0.086),but the post-reversion cognitive re-impairment intensity was 0.138.Reduced MFPC1(HR=0.993,95％Cl:0.991,0.995)and elevated MFPC2(HR=1.004,95％Cl:1.001,1.007)were closely associated with MCI reversion.Conclusion MCI exhibits marked heterogeneity in longitudinal cognitive trajectories.Although reversion is rare,reversed patients remain at high risk of cognitive re-impairment.
