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Mild cognitive impairment: cognitive screening or neuropsychological assessment?
Diniz, Breno Satler;Nunes, Paula Villela;Yassuda, Monica S;Pereira, Fernanda S;Flaks, Mariana K;Viola, Luciane F;Radanovic, Marcia;Abreu, Izabella Dutra de;Borelli, Danilo T;Gattaz, Wagner F;Forlenza, Orestes Vicente;
Revista Brasileira de Psiquiatria , 2008, DOI: 10.1590/S1516-44462008000400003
Abstract: objective: to describe the neuropsychological profile of mild cognitive impairment subtypes (amnestic, non-amnestic and multiple-domain) of a clinical sample. we further address the diagnostic properties of the mini-mental state examination and the cambridge cognitive examination for the identification of the different mild cognitive impairment subtypes in clinical practice. method: cross-sectional clinical and neuropsychological evaluation of 249 elderly patients attending a memory clinic at a university hospital in sao paulo, brazil. results: the performance of patients with mild cognitive impairment was heterogeneous across the different subtests of the neuropsychological battery, with a trend towards an overall worse performance for amnestic (particularly multiple domain) mild cognitive impairment as compared to non-amnestic subtypes. screening tests for dementia (mini-mental state examination and cambridge cognitive examination) adequately discriminated cases of mild alzheimer's disease from controls, but they were not accurate to discriminate patients with mild cognitive impairment (all subtypes) from control subjects. conclusions: the discrimination of mild cognitive impairment subtypes was possible only with the aid of a comprehensive neuropsychological assessment. it is necessary to develop new strategies for mild cognitive impairment screening in clinical practice.
Deterioro cognitivo leve: seguimiento de 10 casos Mild cognitive impairment: follow-up of ten patients
Archibaldo Donoso,María I. Behrens,Pablo Venegas
Revista Chilena de Neuro-Psiquiatría , 2003,
Abstract: En una experiencia clínica inicial, de 36 sujetos diagnosticados como deterioro cognitivo leve (DCL), con un seguimiento clínico de 31 meses promedio, 15 evolucionaron a demencia de tipo Alzheimer, 11 mejoraron y se diagnosticaron como trastornos emocionales, y 10 permanecieron como DCL estables (Donoso et al. 2001). Un seguimiento de 2 a os adicionales del último grupo permitió ver que 5 evolucionaron hacia una demencia (EA probable o mixta); uno mejoró, otro resultó ser una parálisis supranuclear progresiva, y sólo 3 se mantuvieron estables. De estas experiencias se extraen dos conclusiones principales. Primero, que el diagnóstico del DCL no es fácil y puede confundirse con trastornos emocionales en adultos mayores. La segunda es que la mayoría de ellos corresponde a una fase inicial de la EA, sin demencia. Nuestros comentarios son dos. El primero es que no se necesitaría tener una demencia para sospechar o diagnosticar una EA probable. El segundo, que el diagnóstico precoz del DCL permitiría tomar algunas medidas que tal vez impidan o posterguen la aparición de la demencia. 36 patients who presented with mild cognitive impairment (MCI) (memory loss and a Minimental test de Folstein (MMT) of 25-30) had previously been followed up for 31 months: 15 developed Alzheimer dementia, 11 got better (they suffered from emotional disorders) and 10 remained as MCI. In this study we describe an additional follow-up period of two years of the ten patients who persisted with MCI. Five developed dementia (Alzheimer type with or without a vascular component). One got better, one developed a progressive supranuclear palsy, and only 3 remained as MCI. This clinical experience leads us to conclude that it is difficult to differentiate between MCI and emotional disorders in the elderly The second point is that MCI usually represents the prodromal phase of Alzheimer disease. There are two final comments. The first is that the diagnosis of Alzheimer disease could be considered in patients without dementia; the second one, that early diagnosis of MCI may allow the use of drugs which might postpone or even prevent dementia
Comparison of Brief Cognitive Tests and CSF Biomarkers in Predicting Alzheimer’s Disease in Mild Cognitive Impairment: Six-Year Follow-Up Study  [PDF]
Sebastian Palmqvist, Joakim Hertze, Lennart Minthon, Carina Wattmo, Henrik Zetterberg, Kaj Blennow, Elisabet Londos, Oskar Hansson
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038639
Abstract: Introduction Early identification of Alzheimer’s disease (AD) is needed both for clinical trials and in clinical practice. In this study, we compared brief cognitive tests and cerebrospinal fluid (CSF) biomarkers in predicting conversion from mild cognitive impairment (MCI) to AD. Methods At a memory clinic, 133 patients with MCI were followed until development of dementia or until they had been stable over a mean period of 5.9 years (range 3.2–8.8 years). The Mini-Mental State Examination (MMSE), the clock drawing test, total tau, tau phosphorylated at Thr181 (P-tau) and amyloid-β1–42 (Aβ42) were assessed at baseline. Results During clinical follow-up, 47% remained cognitively stable and 53% developed dementia, with an incidence of 13.8%/year. In the group that developed dementia the prevalence of AD was 73.2%, vascular dementia 14.1%, dementia with Lewy bodies (DLB) 5.6%, progressive supranuclear palsy (PSP) 4.2%, semantic dementia 1.4% and dementia due to brain tumour 1.4%. When predicting subsequent development of AD among patients with MCI, the cognitive tests classified 81% of the cases correctly (AUC, 0.85; 95% CI, 0.77–0.90) and CSF biomarkers 83% (AUC, 0.89; 95% CI, 0.82–0.94). The combination of cognitive tests and CSF (AUC, 0.93; 95% CI 0.87 to 0.96) was significantly better than the cognitive tests (p = 0.01) and the CSF biomarkers (p = 0.04) alone when predicting AD. Conclusions The MMSE and the clock drawing test were as accurate as CSF biomarkers in predicting future development of AD in patients with MCI. Combining both instruments provided significantly greater accuracy than cognitive tests or CSF biomarkers alone in predicting AD.
Profile of Cognitive Complaints in Vascular Mild Cognitive Impairment and Mild Cognitive Impairment  [PDF]
Jenny Gu,Corinne E. Fischer,Gustavo Saposnik,Tom A. Schweizer
ISRN Neurology , 2013, DOI: 10.1155/2013/865827
Abstract: Objective. Vascular mild cognitive impairment (VaMCI) is differentiated from mild cognitive impairment (MCI) by the presence of vascular events such as stroke or small vessel disease. Typically, MCI and VaMCI patients present with subjective complaints regarding cognition; however, little is known about the specific nature of these complaints. We aimed to create a profile of subjective cognitive complaints in MCI and VaMCI patients with similar levels of objective cognitive performance. Methods. Twenty MCI and twenty VaMCI patients were recruited from a Memory Disorders Clinic in Toronto. Subjective cognitive complaints were assessed and categorized using the Neuropsychological Impairment Scale. Results. MCI and VaMCI patients achieved similar scores on measures of objective cognitive function ( ). However, the VaMCI group had more subjective complaints than the MCI group ( ), particularly in the critical items, cognitive efficiency, memory, and verbal learning domains of the Neuropsychological Impairment Scale. Conclusions. Our findings support the idea that VaMCI and MCI differ in their clinical profiles, independent of neuroimaging. VaMCI patients have significantly more subjective cognitive complaints and may be exhibiting particular deficits in memory, verbal learning, and cognitive efficiency. Our findings promote the need for further research into VaMCI-specific cognitive deficits. 1. Introduction As adults age, it is common for cognitive problems to arise. Subjective cognitive complaints (SCC) are quite prevalent among older adults, with some estimates suggesting that between 25% and 50% of all older adults have self-perceived memory impairment [1, 2]. In clinical practice, it is often difficult to assess the veracity and severity of subjective cognitive complaints, primarily because such complaints vary widely from individual to individual. As a result, clinicians and caregivers perhaps do not consider subjective complaints to have the same weight as objective findings. However, studies have shown that subjective complaints may be valid indicators of current and future cognitive impairment. A recent study by Amariglio and colleagues showed that certain subjective complaints, such as “I have trouble finding my way around familiar streets,” are correlated with impairment in delayed recall, naming, and semantic fluency [3]. A review conducted by Jonker and colleagues showed that memory complaints may be predictive of dementia or Alzheimer’s disease onset within two to four years, especially in individuals with a diagnosis of mild cognitive
Mild cognitive impairment  [PDF]
Pavlovi? Dragan M.,Pavlovi? Aleksandra M.
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0908434p
Abstract: Mild cognitive impairment (MCI) is a syndrome that spans the area between normal ageing and dementia. It is classified into amnestic and non-amnestic types, both with two subtypes: single domain and multiple domains. Prevalence of MCI depends on criteria and population and can vary from 0.1 to 42% persons of older age. In contrast to dementia, cognitive deterioration is less severe and activities of daily living are preserved. Most impaired higher cognitive functions in MCI are memory, executive functions, language, visuospatial functions, attention etc. Also there are depression, apathy or psychomotor agitation, and signs of psychosis. Aetiology of MCI is multiple, mostly neurodegenerative, vascular, psychiatric, internistic, neurological, traumatic and iatrogenic. Persons with amnestic MCI are at a higher risk of converting to Alzheimer's disease, while those with a single non-memory domain are at risk of developing frontotemporal dementia. Some MCI patients also progress to other dementia types, vascular among others. In contrast, some patients have a stationary course, some improve, while others even normalize. Every suspicion of MCI warrants a detailed clinical exploration to discover underlying aetiology, laboratory analyses, neuroimaging methods and some cases require a detailed neuropsychological assessment. At the present time there is no efficacious therapy for cognitive decline in MCI or the one that could postpone conversion to dementia. The treatment of curable causes, application of preventive measures and risk factor control are reasonable measures in the absence of specific therapy.
Functional Hubs in Mild Cognitive Impairment  [PDF]
Adrián Navas,David Papo,Stefano Boccaletti,F. del-Pozo,Ricardo Bajo,Fernando Maestú,Pedro Gil,Irene Sendi?a-Nadal,Javier M. Buldú
Quantitative Biology , 2013,
Abstract: We investigate how hubs of functional brain networks are modified as a result of mild cognitive impairment (MCI), a condition causing a slight but noticeable decline in cognitive abilities, which sometimes precedes the onset of Alzheimer's disease. We used magnetoencephalography (MEG) to investigate the functional brain networks of a group of patients suffering from MCI and a control group of healthy subjects, during the execution of a short-term memory task. Couplings between brain sites were evaluated using synchronization likelihood, from which a network of functional interdependencies was constructed and the centrality, i.e. importance, of their nodes quantified. The results showed that, with respect to healthy controls, MCI patients were associated with decreases and increases in hub centrality respectively in occipital and central scalp regions, supporting the hypothesis that MCI modifies functional brain network topology, leading to more random structures.
Prevalence of Mild Cognitive Impairment in Individuals Aged over 65 in a Rural Area in North Greece  [PDF]
Magda Tsolaki, Tania Kakoudaki, Anthoula Tsolaki, Eleni Verykouki, Vassiliki Pattakou
Advances in Alzheimer's Disease (AAD) , 2014, DOI: 10.4236/aad.2014.31002
Abstract: There are no data available on the prevalence of Mild Cognitive Impairment (MCI) in Greece, and the existing information about dementia shows important variations depending on the geographical setting as well as the methodology employed. The aim of this study was to determine the prevalence of MCI in individuals aged over 65 in a rural area in the north part of Greece. From 1428 residents, 678 were finally examined, with a mean age of 73.35 years. Assessments, including neuropsychological testing, neurological examination and medical history, were used to assign a diagnosis of normal cognition, mild cognitive impairment (MCI), with or without depression, depression or dementia according to suitable criteria. A questionnaire was also used to obtain social and demographic data. The 26.3% were classified as Mild Cognitive Impaired without depression, the 8.8% as Mild Cognitive Impaired due to depression, 5.9% had sole depression, the 2.4% were diagnosed with dementia and 56.6% had normal mental status. The observed prevalence for MCI with and without depression implies a total of 35.1% of all people aged over 65 with MCI in the study area. Mild cognitive impairment is more prevalent in Greece than dementia, and its subtypes vary in prevalence.
Neurophysiological Biomarker of Mild Cognitive Impairment  [PDF]
Wilfried Dimpfel
Advances in Alzheimer's Disease (AAD) , 2014, DOI: 10.4236/aad.2014.32008
Abstract: Mild cognitive impairment is sometimes regarded as related to aging. However, statistically every second case turns into full dementia, which still is resistant to any treatment. It is therefore desir-able to recognize deviations from normality as early as possible. This might be feasible by using quantitative EEG analysis in the presence of mental work. The present retrospective data analysis revealed a new quantitative biomarker indicating the degree of impairment. Current source density was calculated from 16 channel EEG using CATEEM   software. Four different conditions were analyzed: relaxed state, performing a d2-concentration test, a calculation performance test and a memory test for 5 min each. Subjects older than 40 years were divided into two groups according to their DemTect score: 13 - 18 (HC; n = 44) or 8 - 12 (MCI; n = 45). Spectral power was chopped into six frequency ranges (delta, theta, alpha 1, alpha 2, beta 1 and beta 2). Average spectral power was enhanced in the MCI group in comparison to healthy subjects with respect to delta (p = 0.05) during relaxed state when all electrode positions were regarded. With respect to EEG recording during performance of three different psychometric tests it was recognized that mainly spectral changes during performance of the d2-concentration test were related to mild cognitive impairment. With regard to all electrode positions statistically significantly lower spectral power values were reached during the d2-test for delta (p = 0.001), theta (p = 0.0001) and alpha 1 waves (p = 0.08) in impaired subjects in comparison to healthy subjects. Regarding regions of interest increases of delta and theta power were seen in the fronto-temporal brain during performance of the d2-concentration test. These increases disappeared when looking at MCI data. In the centro-parietal region decreases of alpha and beta 1 power emerged, which were even larger in MCI subjects. No MCI-dependent changes were observed in the other two tests. A correlation was found between psychometric performance of the d2-test and the DemTect score (r = 0.51). MCI subjects had statistically significant worse performance in all three mental challenges in comparison to healthy volunteers. It is concluded that MCI can be characterized at an early stage by EEG recording in the relaxed state. High spectral delta and theta power in general and specifically at fronto- temporal electrode positions (especially at T3) was recognized as a biomarker for MCI. A DemTect score of 8-12 was validated as indicative for MCI.
Mild Cognitive Impairment: Statistical Models of Transition Using Longitudinal Clinical Data  [PDF]
Erin L. Abner,Richard J. Kryscio,Gregory E. Cooper,David W. Fardo,Gregory A. Jicha,Marta S. Mendiondo,Peter T. Nelson,Charles D. Smith,Linda J. Van Eldik,Lijie Wan,Frederick A. Schmitt
International Journal of Alzheimer's Disease , 2012, DOI: 10.1155/2012/291920
Abstract: Mild cognitive impairment (MCI) refers to the clinical state between normal cognition and probable Alzheimer’s disease (AD), but persons diagnosed with MCI may progress to non-AD forms of dementia, remain MCI until death, or recover to normal cognition. Risk factors for these various clinical changes, which we term “transitions,” may provide targets for therapeutic interventions. Therefore, it is useful to develop new approaches to assess risk factors for these transitions. Markov models have been used to investigate the transient nature of MCI represented by amnestic single-domain and mixed MCI states, where mixed MCI comprised all other MCI subtypes based on cognitive assessments. The purpose of this study is to expand this risk model by including a clinically determined MCI state as an outcome. Analyses show that several common risk factors play different roles in affecting transitions to MCI and dementia. Notably, APOE-4 increases the risk of transition to clinical MCI but does not affect the risk for a final transition to dementia, and baseline hypertension decreases the risk of transition to dementia from clinical MCI. 1. Introduction Mild cognitive impairment (MCI) often refers to the clinical condition between normal cognition and probable Alzheimer’s disease (AD). However, persons diagnosed with MCI may progress to non-AD forms of dementia, remain MCI until death, and in some instances recover to a normal cognitive state [1–3]. There has been considerable effort to refine diagnostic criteria, separate MCI into amnestic and nonamnestic subtypes, and identify the underlying etiologies of MCI [1, 4, 5]. However, whether MCI is a true precursor to dementia remains controversial [6–9] despite evidence of AD neuropathology in amnestic MCI [10, 11]. This is due in part to the description of “back transitions” (i.e., recovery to normal cognition) that have been reported in longitudinal studies [3, 9, 12, 13]. Although the long-term prognosis for such cases is unclear, patients with a Clinical Dementia Rating (CDR) global score of 0.5 often have AD pathology at autopsy regardless of back transitions to CDR global scores of 0 [14]. Back transitions are likely heterogeneous in origin and may be explained by misclassification of either the MCI or normal state, interclinician differences in application of diagnostic criteria, within-patient variability due to medical illness or psychosocial factors, or resistance to cognitive decline due to cognitive reserve [15–18]. In a previous study we investigated MCI as defined by cognitive test performance alone.
Visual Personal Familiarity in Amnestic Mild Cognitive Impairment  [PDF]
Luisa Jurjanz,Markus Donix,Eva C. Amanatidis,Shirin Meyer,Katrin Poettrich,Thomas Huebner,Damaris Baeumler,Michael N. Smolka,Vjera A. Holthoff
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020030
Abstract: Patients with amnestic mild cognitive impairment are at high risk for developing Alzheimer's disease. Besides episodic memory dysfunction they show deficits in accessing contextual knowledge that further specifies a general concept or helps to identify an object or a person.
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