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Assessing the progression of mild cognitive impairment to Alzheimer's disease: current trends and future directions

DOI: 10.1186/alzrt52

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A hallmark feature of the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer's Disease and Related Disorders Association criteria for a clinical diagnosis of probable Alzheimer's disease (AD), first established over 25 years ago, was the requirement of a dementia syndrome. The clinician then proceeded to systematically rule out and exclude other neurological and/or medical conditions that might have accounted for the observed cognitive decline. This set of criteria as well as the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) criteria for a dementia syndrome and probable AD [1] were designed to be conservative so that a neurodegenerative condition could not be established unless cognitive function was sufficiently compromised to interfere with an individual's social and/or occupational function.Since AD probably develops many years before cognitive symptoms are manifest [2] and cognitive deficits are evident before the appearance of a full-blown dementia syndrome, increasing attention has been focused on mild cognitive impairment (MCI) as an intermediary state between normal cognition and AD [3,4]. The generally accepted criteria for MCI are the presence of a memory or other cognitive complaint by an individual or other knowledgeable informant, objective deficits on standardized objective cognitive tests and the lack of a dementia syndrome characterized by intact general intellectual function and no significant deficits in social and/or occupational function. As disease-modifying agents are developed, the best hope for prevention or cure lies in treating the disorder in its earliest stages before the brain is severely compromised by multisystem degeneration [5].Efforts at earlier detection of AD face significant challenges in improving assessment of the earliest cognitive and neuropathological changes associated with early AD, identifying those MCI cases that are most likely to progress over time, and gauging t


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