Flashcards in Ger 4 Cognitive Impairment Deck (36)
What is mild cognitive impairment?
An intermediate state of cognitive function between the changes seen in normal aging and those fulfilling the criteria for dementia and often Alzheimer's disease
This is a decline in cognitive function beyond that associated with typical aging, but not as severe of a decline as seen in dementia or Alzheimers
Mild Cognitive Impairment (MCI)
When in neuropsychological testing used and what is it helpful for?
In particularly subtle cases, neuropsychological testing may be helpful to distinguish mild cases of MCI from normal aging (This is the Short Test of Mental Status and the Montreal Cognitive Assessment)
In mild cognitive impairment, is the decline recognized and why whom?
It is recognized by those experiencing it and occasionally by those around them
What is the prevalence (%) of mild cognitive impairment?
10-20% in persons older than 65 years of age
In one study listed, what was the % of patients between 70-89 without dementia who had (1) amnesic MCI and (2) nonamnestic MCI?
What are persons with MCI at an increased risk for developing?
Dementia (significantly increased risk
What is the % progression to dementia in patients with MCI in community-based populations?
What is the % progression to dementia in patients with MCI in specialty clinics
10-15% (compare to 1-2% in the general population)
What is the general rate of progression (to dementia) among those with a diagnosis of MCI?
~10% per year
7 Factors that predict a more rapid progression to dementia?
1. Greater impairment at base line (ie. Degree of cognitive impairment at presentation)
2. Carriers of the apolipoprotein (APOE) 4 allele
3. MRI showing volumetric measurement of the hippocampus that fell at or below the 25th % for age and sex (used for amnestic MCI)
4. MRI showing larger ventricular volumes
5. Hypometabolism in the temporal & parietal regions of the brain on 18FDG-PET may indicate an increased risk of progression from MCI to Alzheimer’s
6. Low levels of β-amyloid peptide 42 (Aβ42) & elevated levels of tau protein in the CSF indicate an increased risk of progression from MCI to Alzheimer’s (Similar risk of progression is seen with a low ratio of Aβ42 to tau in the CSF)
7. Amyloid plaques in the brain (identified using PET scans) suggest a more rapid progression to Alzheimer’s disease
Why should clinicians avoid labeling MCI patients as having early Alzheimer's disease or any similar names?
Because the precise outcome in MCI is not certain (despite MCI being an abnormal condition)
What s dementia?
When cognitive effects are affecting daily functioning to the extent that there is loss of independence in the community
How do you make the diagnosis of dementia?
-By careful history taking
-A diagnosis of dementia can be supported with the use of instruments such as the Functional Activities Questionnaire, which characterizes impairment in function, that is within the range of dementia
What is the prevalence of dementia?
1-2% per year in the US
What happens to cognition in normal aging?
Most people undergo gradual cognitive decline, typically with regard to memory, over their life span. This is usually a minor decline and doesn't compromise the ability to function
What can be done to help distinguish particularly mild cases of MCI from normal aging?
Are there any medications indicated for the treatment of MCI?
No...presently no medication intended for the treatment of MCI has been approved
What did studies conclude about treatment of MCI with agents used for Alzheimer's disease (high-dose vitamin E and donepezil)
No significant reduction in rates of progression to dementia (among patients with MCI who were treated with agents used to treat Alzheimer's disease)
What did the studies mentioned show about the use of donepezil?
One trial showed that donepezil significantly reduced the risk of progression to Alzheimer’s disease for the first 12 months (and for up to 24 months in the subgroup of patients who were carriers of APOE ε4)
*But had no significant effect on the risk of Alzheimer’s disease at 36 months
What did the studies mentioned show about the use of High-dose Vitamin E?
Did not significantly reduce the risk of progression at any point
What showed some evidence of potential benefit in MCI?
Cognitive rehabilitation (Has shown significant improvement in cognitive function at the end of training)
What is included in cognitive rehabilitation?
1. Use of mnemonics
2. Association strategies
3. Computer-assisted training programs
What is seen with the presence of CV risk factors in patients with MCI?
They have an increased risk of progression to dementia
What was seen in the study looking at the benefit of a physical exercise program compared to baseline care and education in patients with subjective memory loss?
The exercise group had better cognitive function at 6 months, with some residual benefit noted at 18 months
What are the 2 types of MCI?
1. Amnestic MCI
2. Nonamnestic MCI
What is amnestic MCI?
Clinically significant memory impairment that doesn't meet the criteria for dementia
--> Memory loss if the most significant feature in this sub-type and is more prominent that that seen in normal aging
What is a description of patients with amnestic MCI and who are the symptoms obvious to?
-These individuals will forget important information that they previously would have remembered (appointment, telephone conversations, recent events that would normally interest them)
-Patients and families are aware of increasing forgetfulness, but it might not be apparent to casual observer)
What happens to other cognitive functions and functional acitivities in amnestic MCI?
-Other cognitive capacities (executive function, use of langues, and visuospatial skills) are relatively preserved
-Functional activities are intact