Cognitive impairment in the nondemented elderly. Results from the Canadian Study of Health and Aging. Arch Neurol 52: 612-619
Department of Pathology, University of Calgary, Alberta. JAMA Neurology
(Impact Factor: 7.42).
To describe a population that was categorized as "cognitively impaired not demented" (CIND) and to examine the utility of some of the proposed criteria for describing this degree of cognitive impairment.
Population-based prevalence study of dementia in those subjects who were 65 years and older.
Community and institutional settings in Canada.
Individuals who underwent a clinical evaluation (N = 2914).
Initial screening with the Modified Mini-Mental State Examination (3MS) to identify potential cognitive impairment; the 3MS was followed by a detailed clinical examination to confirm the presence of dementia and to determine the probable cause. Clinical examinations were performed on all those subjects who were residing in institutions, those in the community with a 3MS score less than 78, and a sample of those in the community with a 3MS score of 78 or more. Neuropsychological testing was performed as part of the clinical examination when the 3MS score was 50 or more. At the conclusion of the assessment, subjects were categorized as being cognitively normal, CIND, and demented.
Frequency of a diagnosis of CIND; demographical, cognitive, and functional characteristics of cognitively normal and CIND subjects and those with early and late dementia; and proportion of subjects who were CIND and met the proposed criteria.
Subjects who were categorized as CIND were common and fell between cognitively normal subjects and those with dementia in terms of age, 3MS score, general intellectual function, and performance of daily activities. Because of the restrictive inclusion and exclusion criteria, the proposed criteria for cognitive impairment described only 30% of our subjects who were CIND.
Subjects who were categorized as CIND appeared to be distinct from and intermediate between subjects with dementia and cognitively normal subjects. Most individuals did not meet the criteria that were evaluated for describing this group. While the various criteria that were evaluated may accurately define a select subset of cognitively impaired individuals, the natural history and prognosis of such groups, currently unknown, may not be generalizable to the larger population of subjects who are CIND. Further work is needed to clearly define this group, and longitudinal studies are required to determine an outcome.
Available from: Ulrich W Preuss
- "RESEARCH ARTICLE number of patients diagnosed as having MCI will become demented, some will remain at the MCI stage for years, and others will return to normal (Ebly et al., 1995; Wolf et al., 1998; Morris et al., 2001; Larrieu et al., 2002). Hence, MCI does not necessarily represent a transitional stage between normal aging and dementia, but a condition associated with an elevated risk of developing dementia (Smith, 2002). "
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The study was conducted to explore the effects of EGb 761® (Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany) on neuropsychiatric symptoms (NPS) and cognition in patients with mild cognitive impairment (MCI).Methods
One hundred and sixty patients with MCI who scored at least 6 on the 12-item Neuropsychiatric Inventory (NPI) were enrolled in this double-blind, multi-center trial and randomized to receive 240 mg EGb 761 daily or placebo for a period of 24 weeks. Effects on NPS were assessed using the NPI, the state sub-score of the State-Trait Anxiety Inventory and the Geriatric Depression Scale. Further outcome measures were the Trail-Making Test (A/B) for cognition and global ratings of change. Statistical analyses followed the intention-to-treat principle.ResultsThe NPI composite score decreased by 7.0 ± 4.5 (mean, standard deviation) points in the EGb 761-treated group and by 5.5 ± 5.2 in the placebo group (p = 0.001). Improvement by at least 4 points was found in 78.8% of patients treated with EGb 761 and in 55.7% of those receiving placebo (p = 0.002). Superiority of EGb 761 over placebo (p < 0.05) was also found for the State-Trait Anxiety Inventory score, the informants' global impression of change, and both Trail-Making Test scores. There were statistical trends favoring EGb 761 in the Geriatric Depression Scale and the patients' global impression of change. Adverse events (all non-serious) were reported by 37 patients taking EGb 761 and 36 patients receiving placebo.ConclusionsEGb 761 improved NPS and cognitive performance in patients with MCI. The drug was safe and well tolerated. Copyright © 2014 John Wiley & Sons, Ltd.
International Journal of Geriatric Psychiatry 10/2014; 29(10). DOI:10.1002/gps.4103 · 2.87 Impact Factor
Available from: Shifu Xiao
- "The reported prevalence of MCI in Europe and North America varies from 2.8 to 17.5%.- The prevalence of MCI in different regions in China varied between 5.4 and 25.0% (11.6% in Beijing in 2004; 15.4% in Guizhou Province in 2005; 5.4% in Taiyuan City in 2006; 9.89% in Xinjiang Province in 2007; 6.3% in Guangzhou City in 2010; and 25.0% in Shaanxi Province in 2011). "
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ABSTRACT: The rapid aging of the Chinese population has spurred interest in research about the cause and prevention of dementia and its precursor, mild cognitive impairment (MCI). This review summarizes the last decade of research in China about MCI. Extensive research about the epidemiology, neuropsychological characteristics, diagnosis, genetic etiology, neuroimaging and electrophysiological changes, and treatment of MCI has provided some new insights but few breakthroughs. Further advances in the prevention and treatment of MCI will require a greater emphasis on multi-disciplinary prospective studies with large, representative samples that use standardized methods to assess and monitor changes in cognitive functioning over time.
Shanghai Archives of Psychiatry 02/2014; 26(1):4-14. DOI:10.3969/j.issn.1002-0829.2014.01.002
Available from: sciencedirect.com
- "There are intermediate categories between cognitive normal state and dementia in old people, classified as cognitive impairment no dementia (CIND)  or mild cognitive impairment (MCI) . CIND is defined as impairments in memory and/or other cognitive domains not sufficiently severe to be classified as dementia and has been suggested to evaluate cognitive impairment in large cohort studies . "
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This study aimed to compare serum cortisol concentrations in cognitively healthy elderly and in subjects with cognitive impairment no dementia (CIND) and dementia, besides to evaluate these concentrations according to apolipoprotein E genotype (APOE).
Three-hundred and nine elderly enrolled in the Pietà Study (Brazil) were divided in 3 groups: control (n=158), CIND (n=92) and dementia (n=59) and had concentrations of morning serum cortisol measured. Hormone concentrations were measured by chemiluminescence and APOE genotypes were determined by PCR followed by restriction fragment length polymorphism (RFLP).
Medians of cortisol concentrations (μg/dl) for the groups were 12.14 (interquartile range - IQR 6.34) for control, 13.65 (IQR 5.88) for CIND and 14.47 (IQR 7.35) for dementia. Significant differences were observed for control vs. CIND (P=0.003), control vs. dementia (P=0.001), but not for CIND vs. dementia (P=0.269). No association was observed between cortisol concentrations and APOE genotype among the groups (P=0.348).
The elevation in cortisol concentrations is associated with dementia, independently of APOE genotypes. Further studies are required to understand if elevation of cortisol is an initial event and how hippocampal damage and the loss of hypothalamus-pituitary-adrenal (HPA) axis inhibition may affect its concentrations.
Clinica chimica acta; international journal of clinical chemistry 04/2013; 423. DOI:10.1016/j.cca.2013.04.013 · 2.82 Impact Factor
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