scholarly journals Clinical referral patterns and cognitive profile in mild cognitive impairment

2008 ◽  
Vol 192 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Jane A. Lonie ◽  
Lucie L. Herrmann ◽  
Claire L. Donaghey ◽  
Klaus P. Ebmeier

BackgroundThere is current interest in exploring the different subtypes of mild cognitive impairment (MCI), in terms of both their epidemiology and their cognitive profile.AimsTo examine the frequency of MCI subtypes presenting to a memory clinic and to document detailed neuropsychological profiles of patients with the amnestic subtype.MethodConsecutive tertiary referrals (n = 187) were psychiatrically evaluated; 45 patients met criteria for amnestic mild cognitive impairment (aMCI). A subgroup of 33 patients with aMCI as well as 21 healthy controls took part in a thorough neuropsychological examination.ResultsOf the patients who were examined in greater neuropsychological detail, ten had pure aMCI (none with visual memory impairment only). Fifteen met criteria for non-amnestic MCI. Fifteen had normal neuropsychological profiles. Using more than one test increased sensitivity to detect episodic memory impairment.ConclusionsAmnestic MCI is an important diagnosis in secondary and tertiary memory clinics. There is scope to improve the efficacy and sensitivity of the clinical assessment of this impairment.

2017 ◽  
Vol 32 (7) ◽  
pp. 401-407 ◽  
Author(s):  
Ilaria Cova ◽  
Giulia Grande ◽  
Valentina Cucumo ◽  
Roberta Ghiretti ◽  
Laura Maggiore ◽  
...  

Aim: To assess memory impairment insight as a predictor of dementia and Alzheimer’s disease (AD) in amnestic mild cognitive impairment (MCI). Methods: To verify whether the awareness of memory impairment assessed by Geriatric Depression Scale (GDS) was associated with the risk of progression to dementia and AD in a cohort of MCI, we used a Cox regression model adjusted for age, sex, education, subtypes of amnestic MCI, Mini-Mental State Examination, Cumulative Illness Rating Scale severity index, and apolipoprotein E genotype. Results: During a follow-up of 27.7 (20.8) months, 205 (63.3%) of 324 patients with amnestic MCI progressed to dementia, including 141 to AD. No association was found in the unadjusted, partially adjusted (for sociodemographic variables), and fully adjusted multivariate Cox analysis between the awareness of memory impairment and the progression to dementia and AD. Discussion: Awareness or anosognosia of memory deficits, identified by GDS, is not useful to predict progression to dementia of patients with amnestic MCI.


2020 ◽  
Vol 17 ◽  
Author(s):  
Hyung-Ji Kim ◽  
Jae-Hong Lee ◽  
E-nae Cheong ◽  
Sung-Eun Chung ◽  
Sungyang Jo ◽  
...  

Background: Amyloid PET allows for the assessment of amyloid β status in the brain, distinguishing true Alzheimer’s disease from Alzheimer’s disease-mimicking conditions. Around 15–20% of patients with clinically probable Alzheimer’s disease have been found to have no significant Alzheimer’s pathology on amyloid PET. However, a limited number of studies had been conducted this subpopulation in terms of clinical progression. Objective: We investigated the risk factors that could affect the progression to dementia in patients with amyloid-negative amnestic mild cognitive impairment (MCI). Methods: This study was a single-institutional, retrospective cohort study of patients over the age of 50 with amyloidnegative amnestic MCI who visited the memory clinic of Asan Medical Center with a follow-up period of more than 36 months. All participants underwent brain magnetic resonance imaging (MRI), detailed neuropsychological testing, and fluorine-18[F18]-florbetaben amyloid PET. Results: During the follow-up period, 39 of 107 patients progressed to dementia from amnestic MCI. In comparison with the stationary group, the progressed group had a more severe impairment in verbal and visual episodic memory function and hippocampal atrophy, which showed an Alzheimer’s disease-like pattern despite the lack of evidence for significant Alzheimer’s disease pathology. Voxel-based morphometric MRI analysis revealed that the progressed group had a reduced gray matter volume in the bilateral cerebellar cortices, right temporal cortex, and bilateral insular cortices. Conclusion: Considering the lack of evidence of amyloid pathology, clinical progression of these subpopulation may be caused by other neuropathologies such as TDP-43, abnormal tau or alpha synuclein that lead to neurodegeneration independent of amyloid-driven pathway. Further prospective studies incorporating biomarkers of Alzheimer’s diseasemimicking dementia are warranted.


2020 ◽  
Vol 17 (4) ◽  
pp. 373-381
Author(s):  
Wuhai Tao ◽  
Jinping Sun ◽  
Xin Li ◽  
Wen Shao ◽  
Jing Pei ◽  
...  

Background: Subjective Memory Impairment (SMI) may tremendously increase the risk of Alzheimer’s Disease (AD). The full understanding of the neuromechanism of SMI will shed light on the early intervention of AD. Methods: In the current study, 23 Healthy Controls (HC), 22 SMI subjects and 24 amnestic Mild Cognitive Impairment (aMCI) subjects underwent the comprehensive neuropsychological assessment and the resting-state functional magnetic resonance imaging scan. The difference in the connectivity of the Default Mode Network (DMN) and Functional Connectivity (FC) from the Region of Interest (ROI) to the whole brain were compared, respectively. Results: The results showed that HC and SMI subjects had significantly higher connectivity in the region of the precuneus area compared to aMCI subjects. However, from this region to the whole brain, SMI and aMCI subjects had significant FC decrease in the right anterior cingulum, left superior frontal and left medial superior frontal gyrus compared to HC. In addition, this FC change was significantly correlated with the cognitive function decline in participants. Conclusion: Our study indicated that SMI subjects had relatively intact DMN connectivity but impaired FC between the anterior and posterior brain. The findings suggest that long-distance FC is more vulnerable than the short ones in the people with SMI.


2020 ◽  
Author(s):  
Miguel Arce Rentería ◽  
Jennifer J. Manly ◽  
Jet M. J. Vonk ◽  
Silvia Mejia Arango ◽  
Alejandra Michaels Obregon ◽  
...  

ABSTRACTINTRODUCTIONWe estimated the prevalence and risk factors for mild cognitive impairment (MCI) and its subtypes in Mexican population using the cognitive aging ancillary study of the Mexican Health and Aging Study.METHODSUsing a robust norms approach and comprehensive neuropsychological criteria, we determined MCI in a sample of adult Mexicans (N=1,807;55-97years). Additionally, we determined prevalence rates using traditional criteria.RESULTSPrevalence of amnestic MCI was 5.9%. Other MCI subtypes ranged 4.3% to 7.7%. MCI with and without memory impairment was associated with older age and rurality. Depression, diabetes and low educational attainment were associated with MCI without memory impairment. Using traditional criteria, prevalence of MCI was lower (2.2% amnestic MCI, other subtypes ranged 1.3%-2.4%).DISCUSSIONOlder age, depression, low education, diabetes, and rurality were associated with increased risk of MCI among older adults in Mexico. Our findings suggest that the causes of cognitive impairment are likely multifactorial and may vary by MCI subtype.Research in ContextSystematic reviewWe reviewed the literature using Google Scholar and PubMed. Few studies have reported prevalence rates for mild cognitive impairment (MCI) in Mexican population. These studies have primarily relied on limited cognitive assessments, and diverse MCI criteria. Evaluating the prevalence of MCI with a robust neuropsychological approach can help understand the rates and risk factors associated with MCI across a large and representative sample of the aging Mexican population.InterpretationVarious sociodemographic and health factors such as older age, depression, low education, diabetes, and rurality were significant correlates of MCI and differed by MCI subtype.Future directionsLongitudinal studies will be needed to evaluate the diagnostic stability of MCI over time, and its association with incident dementia. Future work will evaluate the casual path of these sociodemographic and health factors on cognitive impairment to develop effective interventions.


2014 ◽  
Vol 26 (12) ◽  
pp. 2029-2036 ◽  
Author(s):  
David C Steffens ◽  
Douglas R McQuoid ◽  
Guy G Potter

ABSTRACTBackground:Memory impairment in geriatric depression is understudied, but may identify individuals at risk for development of dementia and Alzheimer's disease (AD). Using a neuropsychologically based definition of amnestic mild cognitive impairment (aMCI) in patients with geriatric depression, we hypothesized that patients with aMCI, compared with those without it, would have increased incidence of both dementia and AD.Methods:Participants were aged 60 years and older and consisted of depressed participants and non-depressed volunteer controls. The depressed cohort met criteria for unipolar major depression. All participants were free of dementia and other neurological illness at baseline. At study entry, participants were administered a standardized clinical interview, a battery of neurocognitive tests, and provided a blood sample for determination of apolipoprotein E genotype. A cognitive diagnosis was assigned by a panel of experts who convened annually and reviewed available clinical, neuropsychological and laboratory data to achieve a consensus cognitive diagnosis to determine a consensus diagnosis. Survival analysis examined the association between aMCI and later dementia (all-cause) and AD.Results:Among 295 depressed individuals, 63 (21.36%) met criteria for aMCI. Among 161 non-depressed controls, four (2.48%) met aMCI criteria. Participants were followed for 6.28 years on average. Forty-three individuals developed dementia, including 40 (13.6%) depressed and three (1.9%) control participants. Both aMCI and age were associated with incident dementia and AD.Conclusions:The presence of aMCI is a poor prognostic sign among patients with geriatric depression. Clinicians should carefully screen elderly depressed adults for memory impairment.


2006 ◽  
Vol 36 (4) ◽  
pp. 507-515 ◽  
Author(s):  
SUVARNA ALLADI ◽  
ROBERT ARNOLD ◽  
JOANNA MITCHELL ◽  
PETER J. NESTOR ◽  
JOHN R. HODGES

Background. We explored the applicability of recently proposed research criteria for mild cognitive impairment (MCI) in a memory clinic and changes in case definition related to which memory tests are used and the status of general cognitive function in MCI.Method. A total of 166 consecutive GP referrals to the Cambridge Memory Clinic underwent comprehensive neuropsychological and psychiatric evaluation.Results. Of 166 cases, 42 were excluded (significant depression 8, established dementia 29 and other disorders 5). Of 124 non-demented, non-depressed patients, 72 fulfilled Petersen's criteria for amnestic MCI based upon verbal memory performance [the Rey Auditory Verbal Learning Test (RAVLT)] and 90 met criteria if performance on verbal and/or non-verbal memory tests [the Rey figure recall or the Paired Associates Learning test (PAL)] was considered. Of the 90 broadly defined MCI cases, only 25 had pure amnesia: other subtle semantic and/or attention deficits were typically present. A further 12 were classed as non-amnestic MCI and 22 as ‘worried well’.Conclusions. Definition of MCI varies considerably dependent upon the tests used for case definition. The majority have other cognitive deficits despite normal performance on the Mini-mental State Examination (MMSE) and intact activities of daily living (ADL) and fit within multi-domain MCI. Pure amnesic MCI is rare.


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