Mild Cognitive Impairment: Clinical Characterization and Outcome

Department of Neurology, Mayo Clinic, Rochester, Minn 55905, USA.
JAMA Neurology (Impact Factor: 7.01). 04/1999; 56(3):303-8. DOI: 10.1001/archneur.56.6.760
Source: PubMed

ABSTRACT Subjects with a mild cognitive impairment (MCI) have a memory impairment beyond that expected for age and education yet are not demented. These subjects are becoming the focus of many prediction studies and early intervention trials.
To characterize clinically subjects with MCI cross-sectionally and longitudinally.
A prospective, longitudinal inception cohort.
General community clinic.
A sample of 76 consecutively evaluated subjects with MCI were compared with 234 healthy control subjects and 106 patients with mild Alzheimer disease (AD), all from a community setting as part of the Mayo Clinic Alzheimer's Disease Center/Alzheimer's Disease Patient Registry, Rochester, Minn.
The 3 groups of individuals were compared on demographic factors and measures of cognitive function including the Mini-Mental State Examination, Wechsler Adult Intelligence Scale-Revised, Wechsler Memory Scale-Revised, Dementia Rating Scale, Free and Cued Selective Reminding Test, and Auditory Verbal Learning Test. Clinical classifications of dementia and AD were determined according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, respectively.
The primary distinction between control subjects and subjects with MCI was in the area of memory, while other cognitive functions were comparable. However, when the subjects with MCI were compared with the patients with very mild AD, memory performance was similar, but patients with AD were more impaired in other cognitive domains as well. Longitudinal performance demonstrated that the subjects with MCI declined at a rate greater than that of the controls but less rapidly than the patients with mild AD.
Patients who meet the criteria for MCI can be differentiated from healthy control subjects and those with very mild AD. They appear to constitute a clinical entity that can be characterized for treatment interventions.

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Available from: Steve Waring, Aug 16, 2015
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    • "However, at the turn of the century, details of the timing of the cascade of antecedent events leading to neurodegeneration and their relationship to clinical phenotypes were lacking [2]. The clinical diagnosis of AD was almost exclusively based on clinical assessment, the apolipoprotein E (APOE) ε4 allele was the primary known genetic AD risk factor, and mild cognitive impairment (MCI) had been recently recognized as a prodromal state of the disease [3] [4]. The pharmaceutical industry was developing disease-modifying treatments to be tested, but clinical trials of these treatments were limited because clinical and cognitive outcome measures were the only ways to detect treatment effects. "
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    • "Thus, the confirmation of a deficit in memory through a reliable instrument is essential for the diagnosis of aMCI (Petersen et al., 1999, 2001). aMCI diagnosis has proven to be clinically useful, as these patients carry a greater risk of conversion to dementia/AD (approximately 12% per year) (Albert et al., 2011; Petersen et al., 1999, 2001), while others may stay in a stable form of selective memory impairment (Dawe, Procter, & Philpot, 1992). In the early stages of AD, neuropathologic changes are already present in medial temporal regions (hippocampal formations, parahippocampal gyrus, and entorhinal cortex), areas which are critical for long-term episodic memory (Blennow, de Leon, & Zetterberg, 2006; Morris et al., 2001; Sarazin et al., 2010). "
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    • "All reported to be functionally independent in activities of daily living, and this was corroborated by a knowledgeable informant. Based on objective cognitive testing (described below), a neuropsychologist (KD) classified the majority of these individuals as cognitively intact (n ¼ 15), with the remainder being characterized as MCI (n ¼ 10) according to existing criteria (Petersen et al., 1999). The MCI individuals exhibited at least an amnestic profile, with memory functioning falling 1.5 SDs below expectations. "
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