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Although there have been meaningful advances in our understanding of the symptoms and underlying pathogenesis of Alzheimer disease (AD), we still cannot predict which individuals with mild cognitive impairment (MCI) will worsen or develop AD. There is a pressing need for identification of optimal clinical biomarkers to predict progression and conversion to dementia in patients with MCI. This important issue is tackled in the current issue of Neurology®. Landau et al.1 compared genetic (APOE ε4 allele frequency), biochemical (CSF Aβ1–42, t-tau, p-tau181p), functional and structural neuroimaging (FDG-PET, hippocampal volume), and cognitive (episodic memory performance) biomarkers in a large group of patients with MCI to determine which combination had the best predictive value for progression or conversion to AD. Their major finding was that patients with amnestic MCI with abnormal FDG-PET and low episodic memory performances were almost 12 times more likely to convert to AD than individuals who were normal on both measures. CSF markers and, marginally, FDG-PET abnormalities were predictors of cognitive decline. Landau et al. concluded that …
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