Objective Individuals with amnestic Mild Cognitive Impairment (MCI) have few empirically-based treatment options for combating their memory loss. This study sought to examine the efficacy of a calendar/notebook rehabilitation intervention, the Memory Support System (MSS), for individuals with amnestic MCI. Methods Forty individuals with single domain amnestic MCI and their program partners were randomized to receive the MSS, either with training or without (controls). Measures of adherence, activities of daily living, and emotional impact were completed at the first and last intervention session and again at 8-weeks and 6 months post intervention. Results Training in use of a notebook/calendar system significantly improved adherence over those who received the calendars but no training. Functional ability and memory self efficacy significantly improved for those who received MSS training. Change in functional ability remained significantly better in the intervention group than in the control group out to 8 week follow up. Care partners in the intervention group demonstrated improved mood by 8 week and 6 month follow-up, while control care partners reported worse caregiver burden by 6 month follow up. Conclusions MSS training resulted in improvement in ADLs and sense of memory self efficacy for individuals with MCI. While ADL benefits were maintained out to 8 weeks post intervention, future inclusion of booster sessions may help extend the therapeutic effect out even further. Improved mood of care partners of trained individuals and worsening sense of caregiver burden over time for partners of untrained individuals further supports the efficacy of the MSS for MCI.

These findings support the position that amnestic MCI represents an early point of decline on the continuum of AD that is different from normal aging.

Objective: To characterize the clinical, radiological, and electrophysiological laboratory profiles and histological features of patients who developed cognitive impairment temporally associated with celiac disease.Design: Case series.Setting: Referral center. Patients:Patients with the onset of progressive cognitive decline within 2 years of symptomatic onset or with a severe exacerbation of biopsy-proved adult celiac disease were identified from the Mayo Clinic medical records from January 1, 1970, to December 31, 2005. Patients were excluded if an alternate cause of their cognitive impairment was identified.Results: Thirteen patients (5 women) were identified. The medianageatcognitiveimpairmentonsetwas64years(range, 45-79 years), which coincided with symptom onset or exacerbation of diarrhea, steatorrhea, and abdominal cramping in 5 patients. Amnesia, acalculia, confusion, and personality changes were the most common presenting features.The average initial Short Test of Mental Status score was 28 of a total of 38 (range, 18-34), which was in the moderately impaired range. The results of neuropsychological testing suggested a trend of a frontosubcortical pattern of impairment. Ten patients had ataxia, and 4 of them also had peripheralneuropathy.Magneticresonanceimagingofthehead showednonspecificT2hyperintensities,andelectroencephalography showed nonspecific diffuse slowing. Deficiencies in folate, vitamin B 12 , vitamin E, or a combination were iden-tifiedin4patients,yetsupplementationdidnotimprovetheir neurological symptoms. Three patients improved or stabilized cognitively with gluten withdrawal. A detailed histological analysis revealed nonspecific gliosis. Conclusions:A possible association exists between progressive cognitive impairment and celiac disease, given the temporal relationship and the relatively high frequency of ataxia and peripheral neuropathy, more commonly associated with celiac disease. Given the impact for potential treatment of similar cases, recognition of this possible association and additional studies are warranted.

Individuals with amnestic Mild Cognitive Impairment (MCI) currently have few treatment options for combating their memory loss. The Memory Support System (MSS) is a calendar and organization system with accompanying 6-week curriculum designed for individuals with progressive memory impairment. Ability to learn the MSS and its utility were assessed in 20 participants. Participants were significantly more likely to successfully use the calendar system after training. Ninety-five percent were compliant with the MSS at training completion, and 89% continued to be compliant at follow-up. Outcome measures revealed a medium effect size for improvement in functional ability. Subjects further reported improved independence, self-confidence, and mood. This initial examination of the MSS suggests that with appropriate training, individuals with amnestic MCI can and will use a memory notebook system to help compensate for memory loss. These results are encouraging that the MSS may help with the symptoms of memory decline in MCI.

Objectives To empirically expand the existing subtypes of mild cognitive impairment (MCI) by incorporating information on neuropsychiatric and functional features, and to assess whether cerebrovascular disease (CVD) risk factors are associated with any of these subgroups. Design Latent class analysis using 1,655 patients with MCI. Setting Participants in the Uniform Data Set (UDS) from 29 NIH Alzheimer’s Disease Centers. Participants Patients with a consensus diagnosis of MCI from each center and with a Mini-Mental State Examination (MMSE) score of 22 or greater. Measurements UDS cognitive battery, Neuropsychiatric Inventory Questionnaire (NPI-Q), and Functional Assessment Questionnaire (FAQ) administered at initial visit. Results Seven empirically-based subgroups of MCI were identified: (1) minimally impaired (relative frequency, 12%); (2) amnestic only (16%); (3) amnestic with functional and neuropsychiatric features (16%); (4) amnestic multi-domain (12%); (5) amnestic multi-domain with functional and neuropsychiatric features (12%); (6) functional and neuropsychiatric features (15%); and (7) executive function and language impairments (18%). Two of these subgroups with functional and neuropsychiatric features were at least 3.8 times more likely than the minimally impaired subgroup to have a Rosen-Hachinski score ≥ 4, an indicator of probable CVD. Conclusions Findings suggest there are several distinct phenotypes of MCI characterized by either prominent cognitive features, prominent functional and neuropsychiatric features, or a combination of all three. Subgroups with functional and neuropsychiatric features are significantly more likely to have CVD, which suggests there might be distinct differences in disease etiology from the other phenotypes.