Mild Cognitive Impairment and Dementia: Definitions, Diagnosis, and Treatment

Abstract

So, you want to enter the lucrative world of dementia evaluations, but it has been a long time since you saw anyone under 65? Then this 2013 contribution by Glenn Smith and Mark Bondi might just be the ticket to get you headed in the right direction. Mild Cognitive Impairment and Dementia: Definitions, Diagnosis, and Treatment is another volume in the American Academy of Clinical Neuropsychology series that follows a strong tradition of authoritative texts that appeal to graduate students and seasoned professionals and all neuropsychologists in between. Smith and Bondi are so extensively published and widely known for their work in aging and dementia that you could not find more qualified experts to guide you through the literature and offer their views on the late life continuum of cognitive disorders. As evident in the introductory chapter, the labels and criteria used to identify various stages of cognitive decline in the elderly have undergone dramatic shifts over the past three decades, with the speed of these changes rapidly increasing. For example, in just the past few years, major revisions have been made to the diagnostic criteria for various cognitive disorders from groups like the National Institute of Aging—Alzheimer's Association and the American Psychiatric Association. Smith and Bondi nicely summarize these changes and expound on future directions. In the second chapter, they also offer us glimpses into the future by identifying five expected roles for neuropsychology in this brave new world of “preclinical” dementia, including using neuropsychological measures as biomarkers and proxy outcomes in clinical trials. But as much as they praise the potential contribution of neuropsychology, they also encourage us to continue to advance our role in this ever-changing niche to remain competitive with neuroimaging and other biomarkers. The following chapters on normal cognitive aging and Mild Cognitive Impairment are excellent summaries of the existing literature on the non-demented side of the continuum. These chapters review a number of their own studies (and their colleagues at Mayo Clinics and University of California San Diego system), which might seem somewhat biased if they were not so germane. Chapters 5–8 cover the “big four” in dementias: Alzheimer's disease, vascular dementia, Dementia with Lewy bodies, and frontotemporal dementia. These are my bread and butter; the cases I see week in and week out. Despite this, I thoroughly enjoyed Smith and Bondi's approach to these chapters. Each chapter starts with a case presentation or two that makes the disorder more concrete. They also address the latest diagnostic criteria, neuropathology associated with the specific etiology, and typical neuropsychology findings from the literature (as well as their own decades of experience with these patients). Tanis Ferman guest authors a delightfully erudite chapter in this section on Dementia with Lewy bodies, which should make anyone feel more comfortable identifying these types of patients. Mild Cognitive Impairment and Dementia ends with chapters on the atypical dementias and interventions for behavioral difficulties in dementias. Under the atypical dementias, guest author David Salmon reviews progressive supranuclear palsy, corticobasal degeneration, posterior cortical atrophy, and other lesser common conditions. The last chapter offers practical recommendations that can be added to most neuropsychological reports to assist patients, families, and other care staff who encounter these non-cognitive symptoms of dementia. As with any book, some readers may be disappointed with certain decisions made by the authors. In this text, very few came to mind for me. In one, the authors review most of the main hypotheses of the neuropathology of Alzheimer's disease (e.g., choline hypothesis, vascular hypothesis, and amyloid cascade hypothesis), but seem to neglect others (e.g., tau and neuroinflammation). Similarly, a sizeable minority of my patients referred for a dementia evaluation do not end up having one of the “big four,” but some other reversible (e.g., autoimmune and metabolic) or non-dementia condition (e.g., depression and delirium). Readers new to this area would have benefitted from a chapter devoted to these conditions, which are frequently considered in the differential diagnosis in older patients with cognitive complaints. Perhaps this will be another volume in this series? Despite these limited concerns, Mild Cognitive Impairment and Dementia: Definitions, Diagnosis, and Treatment kept this informed reader underlining text, tabbing pages, and making notes in the margins. Whether you are a trainee learning about dementia for the first time, preparing for your board certification examination, brushing up on the literature for an upcoming case, or trying to confirm (or refute) what you thought you knew about dementia, this book has much to offer. Finally, what you might lose in reimbursement rates from seeing dementia referrals will surely be made up for in the volume of these cases in the coming years, so be prepared.