Mild Cognitive Impairment: A Neuropsychological Perspective

Brigham and Women's Hospital, Division of Cognitive and Behavioral Neurology, Boston, MA 02115, USA.
CNS spectrums (Impact Factor: 2.71). 02/2008; 13(1):56-64. DOI: 10.1017/S1092852900016163
Source: PubMed


Mild cognitive impairment (MCI) is a clinical diagnosis in which deficits in cognitive function are evident but not of sufficient severity to warrant a diagnosis of dementia. For the majority of patients, MCI represents a transitional state between normal aging and mild dementia, usually Alzheimer's disease. Multiple subtypes of MCI are now recognized. In addition to presentations featuring memory impairment, symptoms in other cognitive domains (eg, executive function, language, visuospatial) have been identified. Neuropsychological testing can be extremely useful in making the MCI diagnosis and tracking the evolution of cognitive symptoms over time. A comprehensive test battery includes measures of baseline intellectual ability, attention, executive function, memory, language, visuospatial skills, and mood. Informant-based measures of neuropsychiatric symptoms, behaviors, and competency in instrumental activity are also included. Careful assessment can identify subtle deficits that may otherwise elude detection, particularly in individuals of superior baseline intellectual ability. As we move closer to disease-modifying therapy for Alzheimer's disease, early identification becomes critical for identifying patients who have an opportunity to benefit from treatment.

Download full-text


Available from: Aaron P Nelson,
153 Reads
  • Source
    • "Research has shown that MCI patients present deficits in executive function [4] and navigation [5] tasks. Virtual reality (VR) applications have been used widely in the field of cognitive rehabilitation and cognitive training. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Recent research advocates the potential of virtual reality (VR) applications in assessing cognitive functions highlighting the possibility of using a VR application for mild cognitive impairment (MCI) screening. Objective: The aim of this study is to investigate whether a VR cognitive training application, the virtual supermarket (VSM), can be used as a screening tool for MCI. Methods: Two groups, one of healthy older adults (n = 21) and one of MCI patients (n = 34), were recruited from day centers for cognitive disorders and administered the VSM and a neuropsychological test battery. The performance of the two groups in the VSM was compared and correlated with performance in established neuropsychological tests. At the same time, the effectiveness of a combination of traditional neuropsychological tests and the VSM was examined. Results: VSM displayed a correct classification rate (CCR) of 87.30% when differentiating between MCI patients and healthy older adults, while it was unable to differentiate between MCI subtypes. At the same time, the VSM correlates with various established neuropsychological tests. A limited number of tests were able to improve the CCR of the VSM when combined with the VSM for screening purposes. Discussion: VSM appears to be a valid method of screening for MCI in an older adult population though it cannot be used for MCI subtype assessment. VSM's concurrent validity is supported by the large number of correlations between the VSM and established tests. It is considered a robust test on its own as the inclusion of other tests failed to improve its CCR significantly.
    Journal of Alzheimer's disease: JAD 11/2014; 44(4). DOI:10.3233/JAD-141260 · 4.15 Impact Factor
  • Source
    • "Since the early descriptions of mild cognitive impairment (MCI) (Petersen et al., 1999), there has been increasing interest in its clinical characterization and prognosis (Nelson and O'Connor, 2008; Correspondence should be addressed to: Dr. Igor Bombin, PhD, Reintegra Foundation, Centro de Rehabilitación Neurológica, C/ Eduardo de Fraga Torrejón, 4, bajo, Oviedo. 33011 Spain. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The longitudinal neuropsychological study of first-episode early-onset psychosis (EOP) patients, whose brain maturation is still in progress at the time of illness onset, provides a unique opportunity to compare their cognitive development with that of healthy subjects, in search of specific patterns resulting from the interaction between neurodevelopmental processes and the presence of psychotic disorders. Method Seventy-five first-episode EOP patients (schizophrenia n = 35; bipolar disorder n = 17; other forms of psychosis n = 23) with a mean age of 15.53 years were assessed with a neuropsychological battery that included measures of attention, working memory, memory and executive functions within 6 months following the onset of the first psychotic symptom (baseline) and 2 years later. Psychotic symptoms were assessed at both times with the Positive and Negative Symptom Scale (PANSS). Seventy-nine healthy subjects matched for age and education served as controls. Results: EOP patients showed significant cognitive impairment at both baseline and the 2-year follow-up, with no significant differences between diagnostic groups at either time. Both healthy controls and EOP patients improved in all cognitive measures, except for patient working memory. Improvement in patient attention lost significance after controlling for psychotic symptom reduction. No significant time/diagnosis interaction was found among patients (p > 0.405). Conclusions: Cognitive impairment in EOP is already present at the first episode, and cognitive development seems to be arrested early in EOP patients compared to their healthy peers, at least for some cognitive functions. These and previous similar results support the neurodevelopmental hypothesis of psychosis.
    Psychological Medicine 07/2012; 43(4):1-12. DOI:10.1017/S0033291712001535 · 5.94 Impact Factor
  • Source
    • "Since the early descriptions of mild cognitive impairment (MCI) (Petersen et al., 1999), there has been increasing interest in its clinical characterization and prognosis (Nelson and O'Connor, 2008; Correspondence should be addressed to: Dr. Igor Bombin, PhD, Reintegra Foundation, Centro de Rehabilitación Neurológica, C/ Eduardo de Fraga Torrejón, 4, bajo, Oviedo. 33011 Spain. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Early definitions of mild cognitive impairment (MCI) excluded the presence of functional impairment, with preservation of a person's ability to perform activities of daily living (ADL) as a diagnostic criterion. However, recent studies have reported varying degrees of functional impairment associated with MCI. Hence, we aimed to test the potential functional impairment associated with MCI and its predictors. Sixty-nine healthy elderly subjects, 115 amnestic single-domain MCI subjects (a-MCI), and 111 amnestic multi-domain MCI subjects (md-MCI) were assessed using a battery of neuropsychological tests including measures of attention, memory, working memory, executive functions, language, and depression. Additionally, functional ability was assessed by both qualitative (WHO-DAS II) and quantitative (CHART) instruments. Cognitive and functional performance was compared between groups, and regression analyses were performed to identify predictors of functional ability. The md-MCI group was more impaired than the a-MCI group, and both were more impaired than healthy subjects in all cognitive measures, in total CHART score, CHART cognitive and mobility subscores, and WHO-DAS II communication and participation subscales. For the rest of the functional measures, the md-MCI group was more impaired than healthy controls. Prediction of functional ability by cognitive measures was limited to md-MCI subjects and was higher for the CHART than for the WHO-DAS II. The WHO-DAS II was largely influenced by depressive symptoms. Functional impairment is a defining feature of MCI and is partially dependent on the degree of cognitive impairment. Quantitative measures of functional ability seem more sensitive to functional impairment in MCI than qualitative measures, which seem to be more related to depression.
    International Psychogeriatrics 04/2012; 24(9):1494-504. DOI:10.1017/S1041610212000622 · 1.93 Impact Factor
Show more