Concepts of mild memory impairment in the elderly and their relationship to dementia—a review

Dawe, Bridget; Procter, Andrew W.; Philpot, Michael

doi:10.1002/gps.930070704

Cited by 81 publications

(50 citation statements)

References 37 publications

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“…There were 45 men and 45 women, with an average of 10.7 years of education (range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The mean duration of reported memory loss prior to presentation was 2.6 years (SD 2.1), with the mean age at symptom onset 71.1 years (SD 8.2).…”

Section: Resultsmentioning

confidence: 99%

“…[15][16][17][18] Progression of MCI patients to dementia (mainly AD) occurs at an initial rate of about 15-30% per year in Memory Clinic samples. 17,[19][20][21][22] Some individuals with MCI, however, remain only mildly impaired for many years, and may never progress to dementia. 23 Visser et al 24 reported that about half of the MCI subjects in a European Memory Clinic progressed to dementia over ten years follow-up.…”

Section: Natural History Of Mild Cognitive Impairmentmentioning

confidence: 99%

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Can Clinical Data Predict Progression to Dementia in Amnestic Mild Cognitive Impairment?

Fellows

Bergman²,

Wolfson³

et al. 2008

Can. j. neurol. sci.

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314As treatments to alleviate symptoms and to slow the progression of Alzheimer's disease (AD) emerge, an increasingly urgent dilemma for physicians is also developing: which of the many elderly individuals with memory complaints will develop Alzheimer's disease, and would therefore be candidates for preventive therapies? An important goal of current research must be to establish useful pre-clinical diagnostic and predictive guidelines, and this can only emerge from longitudinal follow-up of elderly individuals with mild memory loss. In this paper, we report the clinical characteristics of such a group, with the aim of ABSTRACT: Background: To determine whether clinical data obtained by history and physical examination can predict eventual progression to dementia in a cohort of elderly people with mild cognitive impairment. Methods: A prospective, longitudinal study of a cohort of elderly subjects with amnestic Mild Cognitive Impairment (MCI). Ninety subjects meeting the criteria for amnestic MCI were recruited and followed annually for an average of 3.3 years. Main outcome measure was the development of dementia determined by clinical assessment with confirmatory neuropsychological evaluation. Results: Fifty patients (56%) developed dementia on follow-up. They were older, had lower Mini-mental status exam (MMSE) scores and a shorter duration of symptoms at the time of first assessment. Multivariate logistic regression analysis identified age at symptom onset as the only clinical parameter which distinguished the group that deteriorated to dementia from the group that did not. The odds ratio for age was 1.1 (confidence interval 1.04 -1.18). Conclusions: Patients presenting with amnestic MCI insufficient for the diagnosis of dementia are at high risk of developing dementia on follow-up. In our cohort, 56% were diagnosed with dementia over an average period of 5.9 years from symptom onset. The only clinical predictor for the eventual development of dementia was older age at symptom onset. Clinical features alone were insufficient to predict development of dementia.RÉSUMÉ: Les données cliniques peuvent-elles prédire la progression vers la démence dans l'atteinte cognitive légère avec syndrome amnésique? Contexte : Le but de cette étude était de déterminer si les données cliniques provenant de l'histoire médicale et de l'examen physique peuvent prédire la progression éventuelle vers la démence dans une cohorte de gens âgés ayant une atteinte cognitive légère. Méthodes : Il s'agit d'une étude longitudinale prospective d'une cohorte de sujets âgés ayant une atteinte cognitive légère (ACL). Quatre-vingt-dix sujets rencontrant les critères diagnostiques de l'ACL amnésique ont été recrutés et suivis annuellement pendant 3,3 ans en moyenne. Le critère d'évaluation principal était l'apparition d'une démence selon l'évaluation clinique confirmée par une évaluation neuropsychologique. Résultats : Cinquante patients (56%) ont développé une démence au cours du suivi. Ils étaient plus âgés, avaient des scores MMSE plus bas et u...

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Section: Resultsmentioning

confidence: 99%

Section: Natural History Of Mild Cognitive Impairmentmentioning

confidence: 99%

Can Clinical Data Predict Progression to Dementia in Amnestic Mild Cognitive Impairment?

Fellows

Bergman²,

Wolfson³

et al. 2008

Can. j. neurol. sci.

View full text Add to dashboard Cite

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“…Mild cognitive impairment (MCI) is defined as a subjective and objective decline in cognition and function that does not meet criteria for a diagnosis of dementia [1][2][3] and represents a transitional state between the cognition of normal aging and mild dementia. 4 CNS nicotinic acetylcholine receptor stimulation may be a promising strategy to ameliorate symptoms of MCI and slow progression to dementia.…”

mentioning

confidence: 99%

Nicotine treatment of mild cognitive impairment

Newhouse

Kellar²,

Aisen³

et al. 2012

Neurology

178

143

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Objective: To preliminarily assess the safety and efficacy of transdermal nicotine therapy on cognitive performance and clinical status in subjects with mild cognitive impairment (MCI). Methods:Nonsmoking subjects with amnestic MCI were randomized to transdermal nicotine (15 mg per day or placebo) for 6 months. Primary outcome variables were attentional improvement assessed with Connors Continuous Performance Test (CPT), clinical improvement as measured by clinical global impression, and safety measures. Secondary measures included computerized cognitive testing and patient and observer ratings.Results: Of 74 subjects enrolled, 39 were randomized to nicotine and 35 to placebo. 67 subjects completed (34 nicotine, 33 placebo). The primary cognitive outcome measure (CPT) showed a significant nicotine-induced improvement. There was no statistically significant effect on clinician-rated global improvement. The secondary outcome measures showed significant nicotine-associated improvements in attention, memory, and psychomotor speed, and improvements were seen in patient/informant ratings of cognitive impairment. Safety and tolerability for transdermal nicotine were excellent. Conclusion:This study demonstrated that transdermal nicotine can be safely administered to nonsmoking subjects with MCI over 6 months with improvement in primary and secondary cognitive measures of attention, memory, and mental processing, but not in ratings of clinician-rated global impression. We conclude that this initial study provides evidence for nicotine-induced cognitive improvement in subjects with MCI; however, whether these effects are clinically important will require larger studies. Classification of evidence:This study provides Class I evidence that 6 months of transdermal nicotine (15 mg/day) improves cognitive test performance, but not clinical global impression of change, in nonsmoking subjects with amnestic MCI. Neurology ® 2012;78:91-101

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“…3,25,26 Clear diagnosis and prognostication of such patients remains highly challenging. In a recent three year follow-up of 90 such individuals, there were no reliable simple clinical prognostic indicators.…”

Section: Cognitive States Of the Elderlymentioning

confidence: 99%

Assessment of Suspected Dementia

Chertkow

Bergman

Schipper

et al. 2001

Can. J. Neurol. Sci.

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At the Second Canadian Consensus Conference on Dementia (CCCD) (February, 1998), a group of neurologists, geriatricians, and psychiatrists met to consider guidelines for evaluation of dementia in Canada. This review paper formed a background paper for their discussion of dementia diagnosis. These experts from across the country concluded that diagnosis of suspected dementia cases continued to rest on skilled clinical assessment. Mental status exam, preferably in some quantifiable form, has become an essential part of the assessment. Selected laboratory tests are advisable in all cases (CBC, TSH, electrolytes, calcium, and glucose), but the CCCD continued to advise that CT scanning was mandatory only in selected cases where clinical findings pointed to another possibility besides Alzheimer’s disease. The growing list of other diagnostic measures with potential usefulness in diagnosis of Alzheimer’s disease or dementia in general was reviewed, but the evidence was judged as insufficient to support routine use of these tests by physicians. As new treatments for Alzheimer’s disease become available, neurologists face new diagnostic challenges - differentiating Mild Cognitive Impairment, Frontotemporal dementias and Mixed dementias, and Lewy Body Dementia. Guidelines to aid in differential diagnosis are presented.

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Concepts of mild memory impairment in the elderly and their relationship to dementia—a review

Cited by 81 publications

References 37 publications

Can Clinical Data Predict Progression to Dementia in Amnestic Mild Cognitive Impairment?

Can Clinical Data Predict Progression to Dementia in Amnestic Mild Cognitive Impairment?

Nicotine treatment of mild cognitive impairment

Assessment of Suspected Dementia

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