Categories Of Mild Cognitive Impairment Research Articles

Prevalence of Mild Cognitive Impairment in the Lothian Birth Cohort 1936.

The Lothian Birth Cohort 1936 (LBC1936) is a highly phenotyped longitudinal study of cognitive and brain ageing. Given its substantial clinical importance, we derived an indicator of mild cognitive impairment (MCI) and amnestic and nonamnestic subtypes at 3 time points. MCI status was derived at 3 waves of the LBC1936 at ages 76 (n=567), 79 (n=441), and 82 years (n=341). A general MCI category was derived as well as amnestic MCI (aMCI) and nonamnestic MCI (naMCI). A comparison was made between MCI derivations using normative data from the LBC1936 cohort versus the general UK population. MCI rates showed a proportional increase at each wave between 76 and 82 years from 15% to 18%. Rates of MCI subtypes also showed a proportional increase over time: aMCI 4% to 6%; naMCI 12% to 16%. Higher rates of MCI were found when using the LBC1936 normative data to derive MCI classification rather than UK-wide norms. We found that MCI and aMCI rates in the LBC1936 were consistent with previous research. However, naMCI rates were higher than expected. Future LBC1936 research should assess the predictive factors associated with MCI prevalence to validate previous findings and identify novel risk factors.

Observation of Patient and Caregiver Burden Associated with Early Alzheimer's Disease in the United States: Design and Baseline Findings of the GERAS-US Cohort Study1.

Background:Alzheimer’s disease (AD) is one of the costliest diseases in the United States.Objective:To describe aspects of real-world patient and caregiver burden in patients with clinician-diagnosed early AD, including mild cognitive impairment (MCI) and mild dementia (MILD) due to AD.Methods:Cross-sectional assessment of GERAS-US, a 36-month cohort study of patients seeking care for early AD. Eligible patients were categorized based on study-defined categories of MCI and MILD and by amyloid positivity [+] or negativity [–] within each severity cohort. Demographic characteristics, health-related outcomes, medical history, and caregiver burden by amyloid status are described.Results:Of 1,198 patients with clinician-diagnosed early AD, 52% were amyloid[+]. For patients in both cohorts, amyloid[–] was more likely to occur in those with: delayed time to an AD-related diagnosis, higher rates of depression, poorer Bath Assessment of Subjective Quality of Life in Dementia scores, and Hispanic/Latino ethnicity (all p < 0.05). MILD[–] patients (versus MILD[+]) were more medically complex with greater rates of depression (55.7% versus 40.4%), sleep disorders (34.3% versus 26.5%), and obstructive pulmonary disease (11.8% versus 6.6%); and higher caregiver burden (Zarit Burden Interview) (all p < 0.05). MILD[+] patients had lower function according to the Functional Activities Questionnaire (p < 0.001), yet self-assessment of cognitive complaints across multiple measures did not differ by amyloid status in either severity cohort.Conclusions:Considerable patient and caregiver burden was observed in patients seeking care for memory concerns. Different patterns emerged when both disease severity and amyloid status were evaluated underscoring the need for further diagnostic assessment and care for patients.Study Registry:H8A-US-B004; ClinicalTrials.gov: NCT02951598.

\u201cYou\u2019ve got a friend in me\u201d: can social networks mediate the relationship between mood and MCI?

BackgroundSocial networks can change with age, for reasons that are adaptive or unwanted. Social engagement is beneficial to both mental health and cognition, and represents a potentially modifiable factor. Consequently this study explored this association and assessed whether the relationship between mild cognitive impairment (MCI) and mood problems was mediated by social networks.MethodsThis study includes an analysis of data from the Cognitive Function and Ageing Study Wales (CFAS Wales). CFAS Wales Phase 1 data were collected from 2010 to 2013 by conducting structured interviews with older people aged over 65 years of age living in urban and rural areas of Wales, and included questions that assessed cognitive functioning, mood, and social networks. Regression analyses were used to investigate the associations between individual variables and the mediating role of social networks.ResultsHaving richer social networks was beneficial to both mood and cognition. Participants in the MCI category had weaker social networks than participants without cognitive impairment, whereas stronger social networks were associated with a decrease in the odds of experiencing mood problems, suggesting that they may offer a protective effect against anxiety and depression. Regression analyses revealed that social networks are a significant mediator of the relationship between MCI and mood problems.ConclusionsThese findings are important, as mood problems are a risk factor for progression from MCI to dementia, so interventions that increase and strengthen social networks may have beneficial effects on slowing the progression of cognitive decline.

Different subpopulations of mild cognitive impairment are identified by using Petersen's or DSM-5 criteria

ObjectivesIn view of differences in the prevalence and conversion rate to dementia of Petersen's (P-MCI) and DSM-5's (DSM-5-MCI) categories of mild cognitive impairment, this paper is intended to examine the diagnostic agreement between the categories and to analyze clinical factors related to the potential discrepancies. MethodA representative population cohort of 4580 dementia-free individuals 55+ years of age was examined in Zaragoza, Spain (ZARADEMP). Validated Spanish versions of instruments, including the Geriatric Mental State-AGECAT, were used for assessment. Research psychiatrists diagnosed DSM-5-MCI and P-MCI following operationalized criteria. Between-category differences were analyzed, and the statistical methods included the calculation of Cohen's Kappa coefficients of agreement, and the McNemar's test to compare the performance of the intermediate cognitive definitions. ResultsDiagnostic concordance in the classification of MCI cases was very limited. In the total sample, 2.7% of individuals did not meet the P-MCI criteria but met the DSM-5-MCI criteria; and 6.4% met the P-MCI criteria, but not the DSM-5-MCI criteria. Overlap of both categories was observed in only 0.6%. The overall Kappa (agreement between both MCI categories) was 0.08 (95% CI: 0.04–0.12; p<0.001).While no between-category significant differences was observed in cognitive scores, relevant differences in the populations identified had to do with demographic, non-cognitive psychopathological factors, activities of daily living and general health factors. ConclusionsThis study shows ‘poor’ diagnostic agreement between the P-MCI and the DSM-5-MCI categories. The non-cognitive factors should receive special attention when trying to improve the validity of the MCI construct.

From mild cognitive impairment to prodromal Alzheimer disease: A nosological evolution

Despite of the positive medical and scientific advances generated through the mild cognitive impairment (MCI) diagnosis, as we will see along this paper, the concept of MCI presents several major limitations. MCI defines a syndrome and therefore it may be the consequence of different diseases with distinct aetiologies. Furthermore, the philosophy behind the MCI scenario has been to detect a group of symptoms that eventually will evolve into a distinct disease. In contrast, our nowadays aim is to detect a disease in its earlier stages that eventually will evolve from one clinical syndrome to another. As an example, our aim now is to detect early AD that initially will manifest as a memory syndrome and eventually will evolve into a dementia syndrome. Consequently, in order to overcome the syndromical diagnosis behind MCI, the concept of prodromal AD (Prd-AD) has recently emerged. Prd-AD is defined as the symptomatic predementia phase of AD, generally included in the MCI category; this stage is characterised by symptoms not severe enough to meet currently accepted diagnostic criteria for AD. Being a nosological concept, it has several potential advantages related with early diagnosis and treatment, together with the possibility to contribute to the development of disease modifying drugs.

THE ENTANGLEMENT OF RACE AND COGNITIVE DIS/ABILITY

Abstract: To consider blackness and cognitive disability together is paradoxical. On one hand, supposed black intellectual deficit has been used by white elites as a justification for antiblack oppression. On the other, both black children who are struggling in school and black adults labeled with developmental disabilities are less likely than their white counterparts to access the best support services available. These problems cut across a commonly drawn—but, I argue, erroneous—divide between the “judgment” categories of mild cognitive impairment into which black children are disproportionately placed and the “organic” categories of severe cognitive impairment. This division is itself part of the contemporary collective denial of the racialized history and construction of our notion of intellect that ends up harming black Americans.

Constructing the Alzheimer Patient

Identifying a tipping point that might draw a distinction between normal and pathological ageing is a diffi cult task. This paper reviews various steps that lead to establishing a diagnosis of dementia disorders as it is done in a memory clinic. It analyses the way different data is collected in the patient’s daily life. The steps, including a patient’s neurological status, neuropsychological tests and MRI, are interwoven with regard to identifying Alzheimer’s disease. The mild cognitive impairment category that emerges from this process appears as a grey zone, useful to the practitioners and patients despite the controversies underlying the concept. By questioning the performative dynamic stemming from the encounters between patients with cognitive concerns and professionals, this paper intends to fi nd out how this activity contributes to the standardization of the disease outlines, and how this process contributes to separating ageing signs from a pathological way of becoming aged.

Assessing Cognitive Ability in Research: Use of MMSE with Minority Populations and Elderly Adults with Low Education Levels

The Mini-Mental State Examination (MMSE), originally designed to screen for dementia, is an instrument currently used extensively to assess cognitive status in clinical and community settings. This descriptive study compares standard MMSE scores to MMSE scores adjusted for age and education in a sample of 414 elderly Black and White women living independently in communities. After scores were adjusted, 14 participants (all Black) were moved from categories of mild cognitive impairment to unimpaired cognitive ability. However, even after scores were adjusted for age and education, White elderly adults still had higher mean scores than Black elderly adults (p = .003), suggesting that racial differences may have an effect on MMSE performance independent of age and education. Further research is needed to better understand the interaction of race and culture on MMSE outcomes. Implications are offered for appropriate use of the MMSE considering factors of age, education, and racial differences to guide evidence-based practice by gerontological nurses engaged in work with elderly populations.

Multiple cognitive deficits during the transition to Alzheimer's disease.

The literature on cognitive markers in preclinical AD is reviewed. The findings demonstrate that impairment in multiple cognitive domains is typically observed several years before clinical diagnosis. Measures of executive functioning, episodic memory and perceptual speed appear to be most effective at identifying at-risk individuals. The fact that these cognitive domains are most implicated in normal cognitive aging suggests that the cognitive deficit observed preclinically is not qualitatively different from that observed in normal aging. The degree of cognitive impairment prior to the diagnosis of Alzheimer's disease (AD) appears to generalize relatively well across major study characteristics, including sample ascertainment procedures, age and cognitive status of participants, as well as time to diagnosis of dementia. In episodic memory, there is evidence that the size of the preclinical deficit increases with increasing cognitive demands. The global cognitive impairment observed is highly consistent with observations that multiple brain structures and functions are affected long before the diagnosis of AD. However, there is substantial overlap in the distribution of cognitive scores between those who will and those who will not be diagnosed with AD, hence limiting the clinical utility of cognitive markers for early identification of cases. Future research should consider combining cognitive indicators with other types of markers (i.e. social, somatic, genetic, brain-based) in order to increase prediction accuracy.

Deterioro cognitivo leve y enfermedad de Alzheimer inicial en adultos mayores

The early detection of dementia carries implications for clinical management of patients and their families, and it is of utmost concern if an effective pharmacological treatment is to be found. We report the final clinical diagnosis of 36 seniors who complained (or were accused) of forgetfulness. In the Initial Mini-Mental State Examination they scored 25 to 30 out of 30 points and could be diagnosed as having Mild Cognitive Impairment without dementia; preclinical Alzheimer's disease was suspected. Clinical observation (from 6 to 70 months, mean 31) showed that the clinical condition of 15 patients clearly worsened; these were diagnosed as likely Alzheimer's disease patients. Eleven suffered from emotional disturbances and improved with pharmacological and psychosocial treatment; ten of the patients had a static condition and remained in the Mild Cognitive Impairment category. We discuss the frontiers between normal aging, Mild Cognitive Impairment and Alzheimer's disease; we remark the difficulties in the differential diagnosis. Most of the patients with Alzheimer's disease were anosognosics with regard to the memory impairment; this could be a useful clinical point. We also underscore the usefulness of a neuropsychological assessment and the need for continued longitudinal evaluation of subjects with questionable dementia. In the next years, progress in neuropsychological, radiological and biological examinations will lead to improve diagnoses

Predicting who will develop dementia in a cohort of Canadian seniors.

We examined whether easily attainable variables were useful in predicting who became demented over a five year period and determined the rates of incident dementia for different categories of mild cognitive impairment. This was a cohort study of subjects recruited nationally in a population-based survey of Canadians 65 years and older (the Canadian Study of Health and Aging). After standardized clinical assessments, a subset of subjects (n = 1782) was categorized as not demented at time one. Identical study methods allowed a reassessment of the cognitive status of surviving subjects (n = 892) five years later. Three baseline variables (Modified Mini Mental State (3MS) score, subject's age, and an informant's report of the presence of memory problems) were statistically significant predictors of the development of a dementia. An equation incorporating these three variables had a sensitivity of 79% and a specificity of 56% for predicting dementia among survivors at time two. An equation substituting the MMSE for the 3MS showed similar results. The various categories of mild cognitive impairment examined showed significantly different likelihoods for the subsequent development of a dementia. Some categories with a higher dementia risk were characterized by inclusion criteria requiring neuropsychological test scores that were greater than one standard deviation (SD) below the mean of age based normative data. In the absence of extensive laboratory, radiologic or neuropsychological tests, simple variables that can be easily determined in the course of a single clinical encounter were useful in predicting subjects with a higher risk of developing dementia. Attempts to use neuropsychological results to predict the development of dementia should look for significant impairments on age-standardized tests.