Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment

doi:10.1186/s12877-023-04175-8

Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: Increasing research suggests that gait abnormalities can be a risk factor for Alzheimer’s Disease (AD). Notably, there is growing evidence highlighting this risk factor in individuals with amnestic Mild Cognitive Impairment (aMCI), however further studies are needed. The aim of this study is to analyze cognitive tests results and brain-related measures over time in aMCI and examine how the presence of gait abnormalities (neurological or orthopedic) or normal gait affects these trends. Additionally, we sought to assess the significance of gait and gait-related measures as prognostic indicators for the progression from aMCI to AD dementia, comparing those who converted to AD with those who remained with a stable aMCI diagnosis during the follow-up. Methods: Four hundred two individuals with aMCI from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database were included. Robust linear mixed-effects models were used to study the impact of gait abnormalities on a comprehensive neuropsychological battery over 36 months while controlling for relevant medical variables at baseline. The impact of gait on brain measures was also investigated. Lastly, the Cox proportional-hazards model was used to explore the prognostic relevance of abnormal gait and neuropsychological associated tests. Results: While controlling for relevant covariates, we found that gait abnormalities led to a greater decline over time in attention (DSST) and global cognition (MMSE). Intriguingly, psychomotor speed (TMT-A) and divided attention (TMT-B) declined uniquely in the abnormal gait group. Conversely, specific AD global cognition tests (ADAS-13) and auditory-verbal memory (RAVLT immediate recall) declined over time independently of gait profile. All the other cognitive tests were not significantly affected by time or by gait profile. In addition, we found that ventricles size increased faster in the abnormal gait group compared to the normal gait group. In terms of prognosis, abnormal gait (HR = 1.7), MMSE (HR = 1.09), and DSST (HR = 1.03) covariates showed a higher impact on AD dementia conversion. Conclusions: The importance of the link between gait and related cognitive functions in terms of diagnosis, prognosis, and rehabilitation in aMCI is critical. We showed that in aMCI gait abnormalities lead to executive functions/attention deterioration and conversion to AD dementia.

Original language	English
Article number	462
Journal	BMC Geriatrics
Volume	23
Issue number	1
DOIs	https://doi.org/10.1186/s12877-023-04175-8
State	Published - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s).

Funding

This research is funded by the Italian Ministry of Health (SG-2018–12368175) and partially supported by 'Ricerca Corrente' (POSTECH 39C801_2018). Data collection and sharing for this project were funded by the Alzheimer's Disease Neuroimaging Initiative (ADNI) (National Institutes of Health Grant U01 AG024904) and DOD ADNI (Department of Defense award number W81XWH-12-2-0012). ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the following: AbbVie, Alzheimer’s Association; Alzheimer’s Drug Discovery Foundation; Araclon Biotech; BioClinica, Inc.; Biogen; Bristol-Myers Squibb Company; CereSpir, Inc.; Cogstate; Eisai Inc.; Elan Pharmaceuticals, Inc.; Eli Lilly and Company; EuroImmun; F. Hoffmann-La Roche Ltd and its affiliated company Genentech, Inc.; Fujirebio; GE Healthcare; IXICO Ltd.; Janssen Alzheimer Immunotherapy Research & Development, LLC.; Johnson & Johnson Pharmaceutical Research & Development LLC.; Lumosity; Lundbeck; Merck & Co., Inc.; Meso Scale Diagnostics, LLC.; NeuroRx Research; Neurotrack Technologies; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Piramal Imaging; Servier; Takeda Pharmaceutical Company; and Transition Therapeutics. The Canadian Institutes of Health Research is providing funds to support ADNI clinical sites in Canada. Private sector contributions are facilitated by the Foundation for the National Institutes of Health (www.fnih.org). The grantee organization is the Northern California Institute for Research and Education, and the study is coordinated by the Alzheimer’s Therapeutic Research Institute at the University of Southern California. ADNI data are disseminated by the Laboratory for Neuro Imaging at the University of Southern California. Alzheimer’s Disease Neuroimaging Initative Lisa C. Silbert1, Betty Lind1, Rachel Crissey1, Jeffrey A. Kaye1, Raina Carter1, Sara Dolen1, Joseph Quinn1, Lon S. Schneider2, Sonia Pawluczyk2, Mauricio Becerra2, Liberty Teodoro2, Karen Dagerman2, Bryan M. Spann2, James Brewer3, Adam Fleisher3, Helen Vanderswag3, Jaimie Ziolkowski4, Judith L. Heidebrink4, Lisa Zbizek-Nulph4, Joanne L. Lord4, Colleen S. Albers5, Ronald Petersen5, Sara S. Mason5, David Knopman5, Kris Johnson5, Javier Villanueva-Meyer6, Valory Pavlik6, Nathaniel Pacini6, Ashley Lamb6, Joseph S. Kass6, Rachelle S. Doody6, Victoria Shibley6, Munir Chowdhury6, Susan Rountree6, Mimi Dang6, Yaakov Stern7, Lawrence S. Honig7, Akiva Mintz7, Beau Ances8, John C. Morris8, David Winkfield8, Maria Carroll8, Georgia Stobbs-Cucchi8, Angela Oliver8, Mary L. Creech8, Mark A. Mintun8, Stacy Schneider8, David Geldmacher9, Marissa Natelson Love9, Randall Griffith9, David Clark9, John Brockington9, Daniel Marson9, Hillel Grossman10, Martin A. Goldstein10, Jonathan Greenberg10, Effie Mitsis10, Raj C. Shah11, Melissa Lamar11, Patricia Samuels11, Ranjan Duara12, Maria T. Greig-Custo12, Rosemarie Rodriguez12, Marilyn Albert13, Chiadi Onyike13, Leonie Farrington13, Scott Rudow13, Rottislav Brichko13, Stephanie Kielb13, Amanda Smith14, Balebail Ashok Raj14, Kristin Fargher14, Martin Sadowski15, Thomas Wisniewski15, Melanie Shulman15, Arline Faustin15, Julia Rao15, Karen M. Castro15, Anaztasia Ulysse15, Shannon Chen15, P. Murali Doraiswamy16, Jeffrey R. Petrella16, Olga James16, Terence Z. Wong16, Salvador Borges-Neto16, Jason H. Karlawish17, David A. Wolk17, Sanjeev Vaishnavi17, Christopher M. Clark17, Steven E. Arnold17, Charles D. Smith18, Gregory A. Jicha18, Riham El Khouli18, Flavius D. Raslau18, Oscar L. Lopez19, MaryAnn Oakley19, Donna M. Simpson19, Anton P. Porsteinsson20, Kim Martin20, Nancy Kowalski20, Melanie Keltz20, Bonnie S. Goldstein20, Kelly M. Makino20, M. Saleem Ismail20, Connie Brand20, Gaby Thai21, Aimee Pierce21, Beatriz Yanez21, Elizabeth Sosa21, Megan Witbracht21, Brendan Kelley22, Trung Nguyen22, Kyle Womack22, Dana Mathews22, Mary Quiceno22, Allan I. Levey23, James J. Lah23, Ihab Hajjar23, Jeffrey M. Burns24, Russell H. Swerdlow24, William M. Brooks24, Daniel H.S. Silverman25, Sarah Kremen25, Liana Apostolova25, Kathleen Tingus25, Po H. Lu25, George Bartzokis25, Ellen Woo25, Edmond Teng25, Neill R Graff-Radford26, Francine Parfitt26, Kim Poki-Walker26, Martin R. Farlow27, Ann Marie Hake27, Brandy R. Matthews27, Jared R. Brosch27, Scott Herring27, Christopher H. van Dyck28, Adam P. Mecca28, Susan P. Good28, Martha G. MacAvoy28, Richard E. Carson28, Pradeep Varma28, Howard Chertkow29, Susan Vaitekunas29, Chris Hosein29, Sandra Black30, Bojana Stefanovic30, Chris (Chinthaka) Heyn30, Ging-Yuek Robin Hsiung31, Ellen Kim31, Benita Mudge31, Vesna Sossi31, Howard Feldman31, Michele Assaly31, Elizabeth Finger32, Stephen Pasternak32, Irina Rachinsky32, Andrew Kertesz32, Dick Drost32, John Rogers32, Ian Grant33, Brittanie Muse33, Emily Rogalski33, Jordan Robson33, M.-Marsel Mesulam33, Diana Kerwin33, Chuang-Kuo Wu33, Nancy Johnson33, Kristine Lipowski33, Sandra Weintraub33, Borna Bonakdarpour33, Nunzio Pomara34, Raymundo Hernando34, Antero Sarrael34, Howard J. Rosen35, Bruce L. Miller35, Micheal W. Weiner35, David Perry35, Raymond Scott Turner36, Kathleen Johnson36, Brigid Reynolds36, Kelly MCCann36, Jessica Poe36, Gad A. Marshall37, Reisa A. Sperling37, Keith A. Johnson37, Jerome Yesavage38, Joy L. Taylor38, Steven Chao38, Jaila Coleman38, Jessica D. White38, Barton Lane38, Allyson Rosen38, Jared Tinklenberg38, Christine M. Belden39, Alireza Atri39, Bryan M. Spann39, Kelly A. Clark39, Edward Zamrini39, Marwan Sabbagh39, Ronald Killiany40, Robert Stern40, Jesse Mez40, Neil Kowall40, Andrew E. Budson40, Thomas O. Obisesan41, Oyonumo E. Ntekim41, Saba Wolday41, Javed I. Khan41, Evaristus Nwulia41, Sheeba Nadarajah41, Alan Lerner42, Paula Ogrocki42, Curtis Tatsuoka42, Parianne Fatica42, Evan Fletcher43, Pauline Maillard43, John Olichney43, Charles DeCarli43, Owen Carmichael43, Vernice Bates44, Horacio Capote44, Michelle Rainka44, Michael Borrie45, T-Y Lee45, Rob Bartha45, Sterling Johnson46, Sanjay Asthana46, Cynthia M. Carlsson46, Allison Perrin47, Anna Burke47, Douglas W. Scharre48, Maria Kataki48, Rawan Tarawneh48, Brendan Kelley48, David Hart49, Earl A. Zimmerman49, Dzintra Celmins49, Delwyn D. Miller50, Laura L. Boles Ponto50, Karen Ekstam Smith50, Hristina Koleva50, Hyungsub Shim50, Ki Won Nam50, Susan K. Schultz50, Jeff D. Williamson51, Suzanne Craft51, Jo Cleveland51, Mia Yang51, Kaycee M. Sink51, Brian R. Ott52, Jonathan Drake52, Geoffrey Tremont52, Lori A. Daiello52, Jonathan D. Drake52, Marwan Sabbagh53, Aaron Ritter53, Charles Bernick53, Donna Munic53, Akiva Mintz53, Abigail O’Connelll54, Jacobo Mintzer54, Arthur Wiliams54, Joseph Masdeu55, Jiong Shi56, Angelica Garcia56, Marwan Sabbagh56, Paul Newhouse57, Steven Potkin58, Stephen Salloway59, Paul Malloy59, Stephen Correia59, Smita Kittur60, Godfrey D. Pearlson61, Karen Blank61, Karen Anderson61, Laura A. Flashman62, Marc Seltzer62, Mary L. Hynes62, Robert B. Santulli62, Norman Relkin63, Gloria Chiang63, Athena Lee63, Michael Lin63, Lisa Ravdin631Oregon Health & Science University2University of Southern California3University of California – San Diego4University of Michigan5Mayo Clinic, Rochester6Baylor College of Medicine7Columbia University Medical Center8Washington University, St. Louis9University of Alabama—Birmingham10Mount Sinai School of Medicine11Rush University Medical Center12Wien Center13Johns Hopkins University14University of South Florida: USF Health Byrd Alzheimer’s Institute15New York University16Duke University Medical Center17University of Pennsylvania18University of Kentucky19University of Pittsburgh20University of Rochester Medical Center21University of California Irvine IMIND22University of Texas Southwestern Medical School23Emory University24University of Kansas Medical Center25University of California, Los Angeles26Mayo Clinic, Jacksonville27Indiana University28Yale University School of Medicine29McGill Univ., Montreal-Jewish General Hospital30Sunnybrook Health Sciences, Ontario31U.B.C. Clinic for AD & Related Disorders32St. Joseph’s Health Care33Northwestern University34Nathan Kline Institute35University of California, San Francisco36Georgetown University Medical Center37Brigham and Women's Hospital38Stanford University39Banner Sun Health Research Institute40Boston University41Howard University42Case Western Reserve University43University of California, Davis – Sacramento44Dent Neurologic Institute45Parkwood Institute46University of Wisconsin47Banner Alzheimer's Institute48Ohio State University49Albany Medical College50University of Iowa College of Medicine51Wake Forest University Health Sciences52Rhode Island Hospital53Cleveland Clinic Lou Ruvo Center for Brain Health54Roper St. Francis Healthcare55Houston Methodist Neurological Institute56Barrow Neurological Institute57Vanderbilt University Medical Center58Long Beach VA Neuropsychiatric Research Program59Butler Hospital Memory and Aging Program60Neurological Care of CNY61Hartford Hospital, Olin Neuropsychiatry Research Center62Dartmouth-Hitchcock Medical Center63Cornell University

Funders	Funder number
Adam Fleisher3
Alzheimer’s Disease Neuroimaging Initative Lisa C. Silbert1
Ann Marie Hake27
CNY61Hartford Hospital
DOD ADNI
Joseph S. Kass6
Rochester Medical Center21University of California Irvine IMIND22University of Texas Southwestern Medical School23Emory University24University	Ontario31U.B.C
Women's Hospital38Stanford University39Banner Sun Health Research Institute40Boston University41Howard University42Case
National Institutes of Health (NIH)	U01 AG024904
National Institutes of Health (NIH)
U.S. Department of Defense	W81XWH-12-2-0012
U.S. Department of Defense
National Institute on Aging
National Institute of Biomedical Imaging and Bioengineering
University of Southern California
DoD Alzheimer's Disease Neuroimaging Initiative
University of California San Francisco
Northern California Institute for Research and Education
Ministero della Salute	POSTECH 39C801_2018, SG-2018–12368175
Ministero della Salute

Keywords

Cognitive dysfunction
Digit symbol substitution test
Embodiment
Gait abnormalities
Gait assessment
Trail making test

ASJC Scopus subject areas

Geriatrics and Gerontology

Access to Document

10.1186/s12877-023-04175-8

Cite this

@article{40c836c6917d4dedafd13f7064cc7636,

title = "Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment",

abstract = "Background: Increasing research suggests that gait abnormalities can be a risk factor for Alzheimer{\textquoteright}s Disease (AD). Notably, there is growing evidence highlighting this risk factor in individuals with amnestic Mild Cognitive Impairment (aMCI), however further studies are needed. The aim of this study is to analyze cognitive tests results and brain-related measures over time in aMCI and examine how the presence of gait abnormalities (neurological or orthopedic) or normal gait affects these trends. Additionally, we sought to assess the significance of gait and gait-related measures as prognostic indicators for the progression from aMCI to AD dementia, comparing those who converted to AD with those who remained with a stable aMCI diagnosis during the follow-up. Methods: Four hundred two individuals with aMCI from the Alzheimer{\textquoteright}s Disease Neuroimaging Initiative (ADNI) database were included. Robust linear mixed-effects models were used to study the impact of gait abnormalities on a comprehensive neuropsychological battery over 36 months while controlling for relevant medical variables at baseline. The impact of gait on brain measures was also investigated. Lastly, the Cox proportional-hazards model was used to explore the prognostic relevance of abnormal gait and neuropsychological associated tests. Results: While controlling for relevant covariates, we found that gait abnormalities led to a greater decline over time in attention (DSST) and global cognition (MMSE). Intriguingly, psychomotor speed (TMT-A) and divided attention (TMT-B) declined uniquely in the abnormal gait group. Conversely, specific AD global cognition tests (ADAS-13) and auditory-verbal memory (RAVLT immediate recall) declined over time independently of gait profile. All the other cognitive tests were not significantly affected by time or by gait profile. In addition, we found that ventricles size increased faster in the abnormal gait group compared to the normal gait group. In terms of prognosis, abnormal gait (HR = 1.7), MMSE (HR = 1.09), and DSST (HR = 1.03) covariates showed a higher impact on AD dementia conversion. Conclusions: The importance of the link between gait and related cognitive functions in terms of diagnosis, prognosis, and rehabilitation in aMCI is critical. We showed that in aMCI gait abnormalities lead to executive functions/attention deterioration and conversion to AD dementia.",

keywords = "Cognitive dysfunction, Digit symbol substitution test, Embodiment, Gait abnormalities, Gait assessment, Trail making test",

author = "Cosimo Tuena and Sara Maestri and Silvia Serino and Elisa Pedroli and Marco Stramba-Badiale and Giuseppe Riva and Silbert, {Lisa C.} and Betty Lind and Rachel Crissey and Kaye, {Jeffrey A.} and Raina Carter and Sara Dolen and Joseph Quinn and Schneider, {Lon S.} and Sonia Pawluczyk and Mauricio Becerra and Liberty Teodoro and Karen Dagerman and Spann, {Bryan M.} and James Brewer and Adam Fleisher and Helen Vanderswag and Jaimie Ziolkowski and Heidebrink, {Judith L.} and Lisa Zbizek-Nulph and Lord, {Joanne L.} and Albers, {Colleen S.} and Ronald Petersen and Mason, {Sara S.} and David Knopman and Kris Johnson and Javier Villanueva-Meyer and Valory Pavlik and Nathaniel Pacini and Ashley Lamb and Kass, {Joseph S.} and Doody, {Rachelle S.} and Victoria Shibley and Munir Chowdhury and Susan Rountree and Mimi Dang and Yaakov Stern and Honig, {Lawrence S.} and Akiva Mintz and Beau Ances and Morris, {John C.} and David Winkfield and Maria Carroll and Georgia Stobbs-Cucchi and Jicha, {Gregory A.}",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = dec,

doi = "10.1186/s12877-023-04175-8",

language = "English",

volume = "23",

number = "1",

}

TY - JOUR

T1 - Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment

AU - Tuena, Cosimo

AU - Maestri, Sara

AU - Serino, Silvia

AU - Pedroli, Elisa

AU - Stramba-Badiale, Marco

AU - Riva, Giuseppe

AU - Silbert, Lisa C.

AU - Lind, Betty

AU - Crissey, Rachel

AU - Kaye, Jeffrey A.

AU - Carter, Raina

AU - Dolen, Sara

AU - Quinn, Joseph

AU - Schneider, Lon S.

AU - Pawluczyk, Sonia

AU - Becerra, Mauricio

AU - Teodoro, Liberty

AU - Dagerman, Karen

AU - Spann, Bryan M.

AU - Brewer, James

AU - Fleisher, Adam

AU - Vanderswag, Helen

AU - Ziolkowski, Jaimie

AU - Heidebrink, Judith L.

AU - Zbizek-Nulph, Lisa

AU - Lord, Joanne L.

AU - Albers, Colleen S.

AU - Petersen, Ronald

AU - Mason, Sara S.

AU - Knopman, David

AU - Johnson, Kris

AU - Villanueva-Meyer, Javier

AU - Pavlik, Valory

AU - Pacini, Nathaniel

AU - Lamb, Ashley

AU - Kass, Joseph S.

AU - Doody, Rachelle S.

AU - Shibley, Victoria

AU - Chowdhury, Munir

AU - Rountree, Susan

AU - Dang, Mimi

AU - Stern, Yaakov

AU - Honig, Lawrence S.

AU - Mintz, Akiva

AU - Ances, Beau

AU - Morris, John C.

AU - Winkfield, David

AU - Carroll, Maria

AU - Stobbs-Cucchi, Georgia

AU - Jicha, Gregory A.

PY - 2023/12

Y1 - 2023/12

N2 - Background: Increasing research suggests that gait abnormalities can be a risk factor for Alzheimer’s Disease (AD). Notably, there is growing evidence highlighting this risk factor in individuals with amnestic Mild Cognitive Impairment (aMCI), however further studies are needed. The aim of this study is to analyze cognitive tests results and brain-related measures over time in aMCI and examine how the presence of gait abnormalities (neurological or orthopedic) or normal gait affects these trends. Additionally, we sought to assess the significance of gait and gait-related measures as prognostic indicators for the progression from aMCI to AD dementia, comparing those who converted to AD with those who remained with a stable aMCI diagnosis during the follow-up. Methods: Four hundred two individuals with aMCI from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database were included. Robust linear mixed-effects models were used to study the impact of gait abnormalities on a comprehensive neuropsychological battery over 36 months while controlling for relevant medical variables at baseline. The impact of gait on brain measures was also investigated. Lastly, the Cox proportional-hazards model was used to explore the prognostic relevance of abnormal gait and neuropsychological associated tests. Results: While controlling for relevant covariates, we found that gait abnormalities led to a greater decline over time in attention (DSST) and global cognition (MMSE). Intriguingly, psychomotor speed (TMT-A) and divided attention (TMT-B) declined uniquely in the abnormal gait group. Conversely, specific AD global cognition tests (ADAS-13) and auditory-verbal memory (RAVLT immediate recall) declined over time independently of gait profile. All the other cognitive tests were not significantly affected by time or by gait profile. In addition, we found that ventricles size increased faster in the abnormal gait group compared to the normal gait group. In terms of prognosis, abnormal gait (HR = 1.7), MMSE (HR = 1.09), and DSST (HR = 1.03) covariates showed a higher impact on AD dementia conversion. Conclusions: The importance of the link between gait and related cognitive functions in terms of diagnosis, prognosis, and rehabilitation in aMCI is critical. We showed that in aMCI gait abnormalities lead to executive functions/attention deterioration and conversion to AD dementia.

AB - Background: Increasing research suggests that gait abnormalities can be a risk factor for Alzheimer’s Disease (AD). Notably, there is growing evidence highlighting this risk factor in individuals with amnestic Mild Cognitive Impairment (aMCI), however further studies are needed. The aim of this study is to analyze cognitive tests results and brain-related measures over time in aMCI and examine how the presence of gait abnormalities (neurological or orthopedic) or normal gait affects these trends. Additionally, we sought to assess the significance of gait and gait-related measures as prognostic indicators for the progression from aMCI to AD dementia, comparing those who converted to AD with those who remained with a stable aMCI diagnosis during the follow-up. Methods: Four hundred two individuals with aMCI from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database were included. Robust linear mixed-effects models were used to study the impact of gait abnormalities on a comprehensive neuropsychological battery over 36 months while controlling for relevant medical variables at baseline. The impact of gait on brain measures was also investigated. Lastly, the Cox proportional-hazards model was used to explore the prognostic relevance of abnormal gait and neuropsychological associated tests. Results: While controlling for relevant covariates, we found that gait abnormalities led to a greater decline over time in attention (DSST) and global cognition (MMSE). Intriguingly, psychomotor speed (TMT-A) and divided attention (TMT-B) declined uniquely in the abnormal gait group. Conversely, specific AD global cognition tests (ADAS-13) and auditory-verbal memory (RAVLT immediate recall) declined over time independently of gait profile. All the other cognitive tests were not significantly affected by time or by gait profile. In addition, we found that ventricles size increased faster in the abnormal gait group compared to the normal gait group. In terms of prognosis, abnormal gait (HR = 1.7), MMSE (HR = 1.09), and DSST (HR = 1.03) covariates showed a higher impact on AD dementia conversion. Conclusions: The importance of the link between gait and related cognitive functions in terms of diagnosis, prognosis, and rehabilitation in aMCI is critical. We showed that in aMCI gait abnormalities lead to executive functions/attention deterioration and conversion to AD dementia.

KW - Cognitive dysfunction

KW - Digit symbol substitution test

KW - Embodiment

KW - Gait abnormalities

KW - Gait assessment

KW - Trail making test

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U2 - 10.1186/s12877-023-04175-8

DO - 10.1186/s12877-023-04175-8

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VL - 23

JO - BMC Geriatrics

JF - BMC Geriatrics

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ER -

Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment

Abstract

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