The Diagnosis and Management of Mild Cognitive Impairment

Abstract

Importance Cognitive decline is a common and feared aspect of aging. Mild Cognitive Impairment (MCI) is defined as the “symptomatic pre-dementia stage” on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living. Objective To present evidence on the diagnosis,treatment, and prognosis of MCI, and to provide physicians with an evidence-based framework for caring for older MCI patients and their caregivers. Evidence Acquisition We searched PubMed for English-language articles in peer-reviewed journals and the Cochrane Library database through July 2014. Relevant references from retrieved articles were also evaluated. Findings The prevalence of MCI in adults aged ≥65 years is 10- 20%; risk increases with age, and men appear to be at higher risk than women. In older MCI patients, clinicians shouldconsider depression, polypharmacy, and uncontrolled cardiovascular risk factors, all of which may increase risk for cognitive impairment and other negative outcomes. Currently, no medications have proven effective for MCI; treatments and interventions should be aimed at reducing cardiovascular risk factors and prevention of stroke. Aerobic exercise, mental activity, and social engagement may help decrease risk of further cognitive decline. Although patients with MCI are at greater risk of developing dementia compared withthe general population, there is currently substantial variation in risk estimates (from <5% to 20% annual conversion rates), depending on the population studied.Current research is aimed at improving early detection and treatment of MCI, particularly in patients at high risk for progression to dementia. Conclusions and Relevance Cognitive decline and MCI have important implications for patients and their families, and will require that primary care clinicians be skilled in identifying and managing this common disorder as the number of older adults increases in coming decades. Current evidence supports aerobic exercise, mental activity, and cardiovascular risk factor control in patients with MCI.

Impact of 18FDG PET and 11C-PIB PET brain imaging on the diagnosis of Alzheimer’s disease and other dementias in a regional memory clinic in Hong Kong

“…28 In the present study, 50% of MCI patients (ie 2 out of 4) with 18 F-FDG and 11 C-PIB PET imaging findings positive for AD showed deterioration over a followup period of 5 years. Although recommending PET brain imaging in MCI patients is still debatable, we believe that this investigation can help clinicians to better plan future and long-term treatments.…”

Successful Cognitive Aging-Prerequisite of an Improved Quality of Life in Elderly Patients

“…Some cognitive protectors and antioxidants have been reported to help prevent or delay the progression of MCI. However, no supplement has shown any benefit in a clinical trial (Langa & Levine, 2014). [25] Currently, no mild cognitive impairment ( [26]…”

A Novel Non-Pharmaceutical Treatment for Patients with Mild Cognitive Impairment

“…The prevalence of MCI in adults aged 65 years and older is 10% -20%; increasing with age (Langa & Levine, 2014). There are two main clinical subcategories of MCI: amnestic MCI and non-amnestic MCI (Gauthier et al, 2006).…”

“…MCI, especially amnestic, heralds the future onset of dementias, mainly Alzheimer's disease, but also other dementive diseases such as frontotemporal dementias, Lewy body disease, vascular dementia etc (Gauthier et al, 2006). The annual conversion rate in clinical significant dementia ranges from 5% to 20% depending on the population studied (Langa & Levine, 2014).…”

“…low compliance to Mediterranean diet and low folic acid intake), metabolic syndrome, prediabetes and diabetes, depression and polypharmacy (Langa & Levine, 2014;Gauthier et al, 2006;Cooper et al, 2015). So far, no targeted medications (e.g.…”