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: 1.3). 02/2008; 13(1):56-64.
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: Background: Early definitions of mild cognitive impairment (MCI) excluded the presence of functional impairment; instead, preservation of a person's ability to perform activities of daily living (ADL) was a diagnostic criterion. However, recent studies have reported varying degrees of functional impairment associated with MCI. Hence, we aimed to assess the potential functional impairment associated with MCI and its predictors by means of virtual reality. Methods: We assessed 71 healthy elderly subjects, 65 amnestic single-domain MCI subjects (a-MCI), 42 amnestic multi-domain MCI subjects (md-MCI) and 45 mild dementia of Alzheimer's type (mild-AD) subjects using Virtual Reality Activities of Daily Living (VR-ADL). VR-ADL focuses on the subtle errors and pattern in performing everyday activities and has the advantage of not depending on a subjective rating of an individual person. We further assessed functional capacity by both neuropsychological tests (including measures of attention, memory, working memory, executive functions, language, and depression) and also evaluated performance in finger-tapping, grip strength, stride length, gait speed and chair stands separately and while performing VR-ADLs in order to correlate performance in these measures with VR-ADLs. Usual gait speed is a valid and reliable indicator of physical performance, and predicts incident disability, hospitalization, institutionalization, falls, fractures and cognitive decline in elderly persons [1]. We hypothesize that the three cognitively impaired groups will have lower baseline cognitive, VR-ADL and upper-extremity function (UEF) and a greater reduction in performance in subsequent measurements than the cognitively healthy participants. Results: The md-MCI group was more impaired than the a-MCI group, and both were more impaired than healthy subjects in all VR-ADL measures. Also, the mild-AD was significantly more impaired than the MCI groups and healthy controls. Conclusions: Functional - mpairment is a defining characteristic of MCI and is partly dependent on the degree of cognitive impairment. Virtual Reality measures of functional ability seem more sensitive to functional impairment in MCI than qualitative measures. We conclude that VR-ADL is an effective tool for discriminating MCI and mild-AD from control and does so by detecting differences in terms of errors, omissions and perseverations while measuring ADL functional ability.
    Virtual Rehabilitation (ICVR), 2013 International Conference on; 01/2013
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    ABSTRACT: The purpose of this study was to compare the utility of the Rivermead Behavioural Memory Test (RBMT) and the Alzheimer's Disease Assessment Scale-Cognitive part (ADAS-Cog) for the evaluation of mild cognitive impairment (MCI) or very mild Alzheimer's disease (AD). The discriminative abilities of RBMT and ADAS-Cog were compared in the very early stage of AD or MCI patients. Furthermore, we evaluated the difference in both RBMT score and ADAS-Cog score between different severities. Evident superiority in the false negative rate was observed in RBMT over ADAS-Cog in MCI or very mild AD. In addition, 86.7% of the subjects overlooked by ADAS-Cog were correctly detected by RBMT profile score. However, the RBMT score falls in the very early stages and the range of the RBMT score is rather narrow. As a result, it is difficult to evaluate status and follow the progression in severer cases. In contrast to RBMT, the ADAS-Cog score has a wide range and can evaluate and follow the severity in more severe cases. RBMT is more useful than ADAS-Cog in evaluating patients with MCI or very mild AD.
    Psychiatry and Clinical Neurosciences 04/2013; 67(3):148-53. · 2.04 Impact Factor
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    ABSTRACT: This study was carried out to investigate the effect of vitamins E and C on cognitive performance among the elderly in Iran. About 256 elderly with mild cognitive impairment, aged 60-75 years, received 300 mg of vitamin E plus 400 mg of vitamin C or placebo daily just for 1 year. Demographic characteristics, anthropometric variables food consumption, cognitive function by Mini-Mental State Examination (MMSE), and some of the oxidative stress biomarkers were examined. Antioxidant supplementation reduced malondialdehyde level (P < 0.001) and raised total antioxidant capacity (P < 0.001) and glutathione (P < 0.01). The serum 8-hydroxydeoxyguanosine remained unchanged (P < 0.4). After adjusting for the covariates effects, MMSE scores following 6- (25.88 ± 0.17) and 12-month antioxidant supplementation (26.8 ± 0.17) did not differ from control group (25.86 ± 0.18 and 26.59 ± 0.18, respectively). Despite significant improvement in most of the oxidative stress biomarkers, antioxidants' supplementation was not observed to enhance cognitive performance. A large number of kinetic and/or dynamic factors could be suspected.
    European Journal of Nutrition 12/2013; · 3.84 Impact Factor

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