Treatment Of Mild Cognitive Impairment Research Articles

Evidence ‘Insufficient’ for Cognitive-Impairment Screening

Citing an ongoing lack of data about the benefits and harms of screening, the U.S. Preventive Services Task Force has left unchanged the recommendations of its 2003 guidelines on cognitive-impairment screening in older adults, according to an update published recently. “Evidence on the effect of screening and early detection of mild to moderate dementia on decision making, planning, or other important patient outcomes is a critical gap in the evidence,” Virginia A. Moyer, MD, said in a report on behalf of the USPSTF. Other research needs include further study of the harms of screening, new interventions that address the changing needs of patients and families, and interventions that affect the long-term clinical direction of mild-to-moderate dementia. In its review, the USPSTF evaluated 55 studies on instruments that screen for cognitive impairment, of which 46 provided evidence on the sensitivity of dementia screening and 27 provided evidence on mild cognitive impairment. Screening tests included a variety of tasks to assess at least one cognitive function, such as memory, attention, language, and visuospatial/executive functioning. The USPSTF looked at studies that used the Mini-Mental State Examination (MMSE), Clock Drawing Test, verbal fluency tests, Informant Questionnaire on Cognitive Decline in the Elderly, Memory Impairment Screen, Mini-Cog Test, Abbreviated Mental Test, and Short Portable Mental Status Questionnaire. The MMSE was the most-evaluated screening tool, with 25 published studies in people 69-95 years old. Mean prevalence of dementia ranged from 1.2% to 38%. The pooled sensitivity from 14 studies for the most commonly reported cut points was 88.3% (95% confidence interval, 81.3%-92.9%), and specificity was 86.2% (CI, 81.8%-89.7%). Other screening tools “were studied in far fewer studies (four to seven studies each), had limited reproducibility in primary care relevant populations, and had unknown optimum cut points,” Dr. Moyer wrote. In addition, no trial compared clinical and decision-making outcomes in screened and unscreened patients, the report said. And no study probed the consequences of false-positive or false-negative screening results, such as psychological harms, unnecessary diagnostic testing, or stigmatization. Types of dementia in older adults include Alzheimer's disease, vascular dementia, frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease with dementia, and mixed-cause dementia. The USPSTF distinguishes between dementia and mild cognitive impairment, which is defined as less severe and not considerably interfering with day-to-day activities. The prevalence of dementia is estimated to be 5% in adults aged 71-79 years of age, 24% in those aged 80-89 years, and 37% in those aged 90 years and older. The prevalence of mild cognitive impairment is more uncertain, and estimates range from 3% to 42% in adults aged 65 years and older. This report differs from the 2003 recommendations because it considers screening and treatment for mild cognitive impairment, as well as dementia, and it includes additional information about the performance of screening instruments. “The overall evidence is insufficient to make a recommendation on screening,” Dr. Moyer said. Editor's NoteWhether the harms of screening for cognitive impairment outweigh the benefits in the general population, everybody gets tested in our nursing homes. The Brief Inventory of Mental Status is performed on every resident no less frequently than quarterly. So we have a screening test and a surveillance test right there in the chart. The BIMS certainly can be helpful to us as clinicians in several ways, so don't forget that it's in there, along with the PHQ-9 depression inventory.—Karl Steinberg, MD, CMD Editor in Chief Whether the harms of screening for cognitive impairment outweigh the benefits in the general population, everybody gets tested in our nursing homes. The Brief Inventory of Mental Status is performed on every resident no less frequently than quarterly. So we have a screening test and a surveillance test right there in the chart. The BIMS certainly can be helpful to us as clinicians in several ways, so don't forget that it's in there, along with the PHQ-9 depression inventory. —Karl Steinberg, MD, CMD Editor in Chief

Rationale and clinical data supporting nutritional intervention in Alzheimer’s disease

Adequate nutrition plays an important role in the maintenance of cognitive function, particularly during aging. Malnutrition is amongst the risk factors for developing mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Epidemiological studies have associated deficiencies in some nutrients with a higher risk of cognitive dysfunction and/or AD.Cognitive decline in AD is correlated with synaptic loss and many of the components required to maintain optimal synaptic function are derived from dietary sources. As synapses are part of the neuronal membrane and are continuously being remodelled, the availability of sufficient levels of nutritional precursors (mainly uridine monophosphate, choline and omega-3 fatty acids) to make the phospholipids required to build neuronal membranes may have beneficial effects on synaptic degeneration in AD. In addition, B-vitamins, phospholipids and other micronutrients act as cofactors to enhance the supply of precursors required to make neuronal membranes and synapses. Despite this, no randomized controlled trial has hitherto provided evidence that any single nutrient has a beneficial effect on cognition or lowers the risk for AD. However, a multi-target approach using combinations of (micro)nutrients might have beneficial effects on cognitive function in neurodegenerative brain disorders like AD leading to synaptic degeneration.Here we review the clinical evidence for supplementation, based on a multi-target approach with a focus on key nutrients with a proposed role in synaptic dysfunction. Based on preclinical evidence, a nutrient mixture, Souvenaid® (Nutricia N.V., Zoetermeer, The Netherlands) was developed. Clinical trials with Souvenaid® have shown improved memory performance in patients with mild AD. Further clinical trials to evaluate the effects of nutritional intervention in MCI and early dementia due to AD are on-going.

Treatment of Psychosis and Dementia in Parkinson’s Disease

Parkinson's disease (PD) has been increasingly recognized as having a multitude of nonmotor symptoms including psychosis, cognitive impairment and dementia, mood disturbances, fatigue, apathy, and sleep disorders. Psychosis and dementia, in particular, greatly affect quality of life for both patients and caregivers and are associated with poor outcomes. Safe and effective treatment options for psychosis and dementia in PD are much needed. Antipsychotics with dopamine-blocking properties can worsen parkinsonian motor features and have been associated with increased morbidity and mortality in elderly, dementia patients. For treating PD psychosis, a first step would be eliminating confounding variables, such as delirium, infections, or toxic-metabolic imbalances, followed by simplifying parkinsonian medications as tolerated. If additional treatment is warranted after such interventions, clozapine or quetiapine can be implemented at the low dose levels typically needed by PD patients. Although quetiapine is easy-to-use in clinical settings, does not require blood count monitoring like clozapine, and is anecdotally beneficial, it remains "investigational" in evidence-based medicine reviews. Though not currently available, the novel 5-HT2a inverse agonist, pimavanserin has shown promise in the treatment of PD psychosis. Current treatments for PD dementia are mostly derived from those utilized in Alzheimer's disease, focusing mainly on cholinesterase inhibitors and memantine, a NMDA receptor antagonist. Rivastigmine, the only Food and Drug Administration approved medication for PD dementia, is a reasonable first choice. Other cholinesterase inhibitors and memantine have not yet achieved recommendation status in evidence-based medicine reviews but are well tolerated in studies of PD dementia patients. At present, there are no approved treatments for mild cognitive impairment in PD, but rasagiline, a selective MAO-B inhibitor, and atomoxetine, a serotonin norepinephrine reuptake inhibitor, have been recently studied. Nonpharmacological interventions, including cognitive therapy, physical activity, music and art therapy, and noninvasive brain stimulation techniques, may be promising options for PD cognitive impairment but await rigorous study.

NMDA Neurotransmission Dysfunction in Mild Cognitive Impairment and Alzheimer’s Disease

The prevalence of Alzheimer's disease (AD) in the elderly is growing rapidly worldwide, and the deteriorating clinical course of AD places a heavy burden on both the patients and their families. Early detection and intervention of mild cognitive impairment in the early phase of AD is vital for the purpose of improving the cognitive performance of patients and preventing the existing deficits from worsening. However, the main compounds currently used to treat early AD, acetylcholinesterase inhibitors (AChEIs), are unsatisfactory in efficacy and safety. Moreover, evidence indicates that AChEIs are ineffective in treating AD at extremely early stages, which implies that mechanisms other than those targeted by AChEIs underlie the pathogenesis of AD. Dysfunctional glutamatergic neurotransmission, particularly that mediated by the N-methyl-D-aspartate (NMDA) receptor, has been reported to play a role in the pathophysiology of AD. The NMDA receptor (NMDAR) regulates synaptic plasticity, memory, and cognition, and the attenuation of NMDAR-mediated neurotransmission can result in impaired neuroplasticity and cognitive deficits in the aging brain. Furthermore, NMDARs also interact with amyloid beta peptide/amyloid precursor protein and tau protein, whose production represents the main manifestations of AD. In this paper, we review the evidence supporting NMDA dysfunction in both animal models of AD and patients afflicted with AD, and we also review the literature that suggests that NMDA-enhancing agents such as glycine and D-cycloserine can improve cognitive functions. The benefits and limitations of NMDAR antagonists that can diminish the excitatory neurotoxicity triggered by glutamate are also addressed in relation to AD. We propose that enhancing glutamatergic neurotransmission by activating the NMDAR may be effective in treating the cognitive decline that occurs in AD. Prospective studies on AD in which NMDA-enhancing agents are used are required to verify this hypothesis and confirm the long-term efficacy and safety of the treatment agents.

Communication Difficulty and Relevant Interventions in Mild Cognitive Impairment: Implications for Neuroplasticity.

Mild Cognitive Impairment (MCI) represents a critical point for controlling cognitive decline. Patterns of communication difficulty have been observed in patients with MCI and warrant examination and management. The present systematic review examined (1) characteristics of communication difficulty in MCI by focusing on two domains: expressive and receptive communication, and (2) cognitive interventions that addressed communication difficulties in individuals with MCI. Of the 28 observational studies we reviewed, expressive and receptive communications were generally impaired in individuals with MCI, compared to their healthy counterparts. However, only one of seven interventions effectively improved communication related outcomes. We finished the paper with a discussion about how neuroplasticity influences communication abilities in individuals with MCI to inform the future development of interventions for communication difficulty.

Mild Cognitive Impairment and Anti-Alzheimer Disease Medications: A Cross Sectional Study of the French National Alzheimer Databank (BNA)

Unlike Alzheimer's disease (AD), there are no drugs approved for the treatment of mild cognitive impairment (MCI). The objective of this study was to evaluate real world prescriptions of anti-AD medications in patients with MCI in France and to determine characteristics associated with treatment. A cross sectional study of the French National Alzheimer Databank (BNA) was conducted. Patients diagnosed with MCI by physicians of the BNA network in 2010 and 2011 were included in this study. We included 16,236 patients with a diagnosis of MCI in the study. Mean age was 76.4 years old and females were 59.5%. Nine hundred eighty five patients (6.1%) were taking an anti-AD medication. Results of a multivariate analysis show that use was associated with older age, lower MMSE score, amnestic MCI subtype, living at home, and higher education. Treatment with antidepressant drugs was also associated with anti-AD medication use (odd ratio: 1.68; 95% confidence interval: 1.44 to 1.96). "Off label" prescription of anti-AD drugs is low in France and seems to be limited to a population at risk of conversion to AD. Similar analysis will be required to monitor this practice in the future.

Therapy for memory and attention impairments in young patients

Objective. To study the efficacy and tolerance of tanakan in the treatment of mild cognitive impairment in young patients. Patients and methods. The study enrolled 30 patients whose mean age was 33.5±7.5 years. It used clinical neurological examination; a test for rating general condition, activity, and mood; studies to evaluate aural short-term and verbal short-term memories and to estimate the level of attention using Schulte's tables, and questionnaires for the rating of autonomic disorders and nocturnal sleep quality, those for the patient subjective assessment of treatment efficiency and for the recording of adverse reactions. Results. Tanakan therapy led to the normalized emotional status in the patients, improved nocturnal sleep, and reduced autonomic disorders. There was a tendency towards improvement of all characteristics of attention. Aural and verbal memories became better. Conclusion. Tanakan is an effective and safe drug to treat cognitive impairment at any age.

Treatment for mild cognitive impairment: systematic review

More people are presenting with mild cognitive impairment (MCI), frequently a precursor to dementia, but we do not know how to reduce deterioration. To systematically review randomised controlled trials (RCTs) evaluating the effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality or incident dementia. We reviewed 41 studies fitting predetermined criteria, assessed validity using a checklist, calculated standardised outcomes and prioritised primary outcome findings in placebo-controlled studies. The strongest evidence was that cholinesterase inhibitors did not reduce incident dementia. Cognition improved in single trials of: a heterogeneous psychological group intervention over 6 months; piribedil, a dopamine agonist over 3 months; and donepezil over 48 weeks. Nicotine improved attention over 6 months. There was equivocal evidence that Huannao Yicong improved cognition and social functioning. There was no replicated evidence that any intervention was effective. Cholinesterase inhibitors and rofecoxib are ineffective in preventing dementia. Further good-quality RCTs are needed and preliminary evidence suggests these should include trials of psychological group interventions and piribedil.

Semantic Memory Functional MRI and Cognitive Function after Exercise Intervention in Mild Cognitive Impairment

Mild cognitive impairment (MCI) is associated with early memory loss, Alzheimer's disease (AD) neuropathology, inefficient or ineffective neural processing, and increased risk for AD. Unfortunately, treatments aimed at improving clinical symptoms or markers of brain function generally have been of limited value. Physical exercise is often recommended for people diagnosed with MCI, primarily because of its widely reported cognitive benefits in healthy older adults. However, it is unknown if exercise actually benefits brain function during memory retrieval in MCI. Here, we examined the effects of exercise training on semantic memory activation during functional magnetic resonance imaging (fMRI). Seventeen MCI participants and 18 cognitively intact controls, similar in sex, age, education, genetic risk, and medication use, volunteered for a 12-week exercise intervention consisting of supervised treadmill walking at a moderate intensity. Both MCI and control participants significantly increased their cardiorespiratory fitness by approximately 10% on a treadmill exercise test. Before and after the exercise intervention, participants completed an fMRI famous name discrimination task and a neuropsychological battery, Performance on Trial 1 of a list-learning task significantly improved in the MCI participants. Eleven brain regions activated during the semantic memory task showed a significant decrease in activation intensity following the intervention that was similar between groups (p-values ranged 0.048 to 0.0001). These findings suggest exercise may improve neural efficiency during semantic memory retrieval in MCI and cognitively intact older adults, and may lead to improvement in cognitive function. Clinical trials are needed to determine if exercise is effective to delay conversion to AD.

L-Carnitine Consumption, Its Metabolism by Intestinal Microbiota, and Cardiovascular Health

arch, I n early April 2013, Koeth et al 1 published in Nature Medicine an original article providing evidence that ingested L-carnitine can encourage the growth of intestinal microbiota capable of converting carnitine to trimethylamine; the latter compound, on absorption, can be oxidized in the liver to trimethylamine-N-oxide (TMAO), which the authors suggested was likely to be a key mediator of the adverse impact of red meaterich diets on human vascular health. This report immediately gained attention in the nation’s media. For example, Koeth et al’s research was a highlighted story on the CBS Evening News With Scott Pelley on the evening of Friday, April 5, 2013, and by Sunday, April 7, Gina Kolata of the New York Times had cited this research in an article questioning the safety of carnitine. Within days of this report,Mayo Clinic Proceedings electronically published ahead of print a meta-analysis by DiNicolantonio et al of 13 placebo-controlled clinical trials enrolling 3629 patients that had evaluated the clinical impact of L-carnitine administration (as a supplement, not in red meat) in patients who had previously experienced amyocardial infarction. This meta-analysis concluded that carnitine administration was associated with clinical benefit: decreased mortality and reduced onset of cardiac arrhythmias and angina. The journal also issued a press release noting the findings of DiNicolantonio et al and their relevance to the report by Koeth et al. Other media sources seized on the seeming inconsistency of these reports, with websites such as Forbes.com, hearthealth.com, and junkscience.com offering commentary. This second wave of media reports was followed shortly thereafter by many hundreds of media stories on one or both of the L-carnitine studies. In publications focusing on choline, which, similar to carnitine, can be converted to trimethylamine by intestinal microbiota, Koeth and his colleagues have made a case that TMAO may be a mediating risk factor for atherosclerosis.

A Pilot Study of Training and Compensation Interventions for Mild Cognitive Impairment

Background: This pilot clinical trial sought to estimate the feasibility and efficacy of two interventions aimed at improving memory performance in geriatric clinic patients with mild cognitive impairment. Methods: Fifteen participants were randomized to either a memory training group or a memory compensation group. Results: Recruitment rates were low, whereas adherence and retention rates were acceptable. The memory training group improved in self-reported memory abilities and satisfaction with memory. The memory compensation group improved on one objective memory test but showed no consistent changes on any other outcomes. Conclusion: Effect size estimates will inform the design of larger clinical trials.

Pilot testing a couples-focused intervention for mild cognitive impairment.

The purpose of this pilot was to evaluate the acceptability, feasibility, and potential benefits of the multicomponent, Daily Enhancement of Meaningful Activity (DEMA) intervention, which was tailored to help couples facing mild cognitive impairment (MCI) work together to meet goals, remain engaged in meaningful activities, and adapt to changes over time. Using a single-group design, 10 individuals with MCI and their family caregivers were recruited to participate in the DEMA intervention over 6 biweekly sessions. Data were collected pre-and at 1 week and 3 months postintervention completion rates indicated the program and study procedures were well accepted. Qualitative and quantitative finding indicated positive trends in meaningful activity performance and maintenance of health-related outcomes, as well as high program satisfaction. The DEMA intervention is potentially promising but needs further testing in a randomized clinical trial.

Cost Template for Meaningful Activity Intervention for Mild Cognitive Impairment

The objective of the study was to describe and compare cost estimates for a pilot study of the Daily Enhancement of Meaningful Activity intervention for persons with mild cognitive impairment-caregiver dyads. The increasing complexity of the healthcare system and rising healthcare costs have forced nurse scientists to find ways to effectively improve healthcare quality and control cost, but no studies have examined costs for new programs that target persons with mild cognitive impairment-caregiver dyads. Pilot study data were used to develop a cost template and calculate the cost of implementing the Daily Enhancement of Meaningful Activity. Mean cost per dyad was estimated to be $1327.97 in the clinical setting, compared with $1069.06 if a telephone delivery mode had been used for 4 of the 6 face-to-face sessions. This difference was largely due to transportation-related expenses and staff cost. : Daily Enhancement of Meaningful Activity should be evaluated further with larger and more diverse samples as a technology-delivered health promotion program that could reduce costs.

Pharmacological Treatment of Mild Cognitive Impairment as a Prodromal Syndrome of Alzheimer´s Disease.

Mild cognitive impairment (MCI) is a syndrome which, depending on various neurobiological, psychological and social factors, carries a high risk of developing into dementia. As far as diagnostic uncertainty and the heterogeneous underlying pathophysiological mechanisms are concerned, only limited therapeutic options are currently available. Clinical trials involving a wide range of substances have failed to show efficacy on primary and secondary outcome parameters. Most results reflect not only a lack of effectiveness of drug therapy but also methodological constraints in true prodromal Alzheimer´s disease (AD) based on clinical criteria. Biomarkers may help to identify MCI as a prodromal phase of dementia, so it is important to use them to improve specificity of case selection in future studies. For MCI as a prodromal syndrome of AD, clinical trials with disease modifying drugs that target underlying pathological mechanisms such as amyloid-beta accumulation and neurofibrillary tangle formation may help develop effective treatment options in the future. Alternative pharmacological approaches are currently being evaluated in ongoing phase 1 and phase 2 studies. Nevertheless, a lack of approved pharmacotherapeutic options has led to specific interventions that focus on patient education and life-style related factors receiving increasing attention.

Pharmacological Treatment of Mild Cognitive Impairment as a Prodromal Syndrome of Alzheimer´s Disease

Mild cognitive impairment (MCI) is a syndrome which, depending on various neurobiological, psychological and social factors, carries a high risk of developing into dementia. As far as diagnostic uncertainty and the heterogeneous underlying pathophysiological mechanisms are concerned, only limited therapeutic options are currently available. Clinical trials involving a wide range of substances have failed to show efficacy on primary and secondary outcome parameters. Most results reflect not only a lack of effectiveness of drug therapy but also methodological constraints in true prodromal Alzheimer´s disease (AD) based on clinical criteria. Biomarkers may help to identify MCI as a prodromal phase of dementia, so it is important to use them to improve specificity of case selection in future studies. For MCI as a prodromal syndrome of AD, clinical trials with disease modifying drugs that target underlying pathological mechanisms such as amyloid-beta accumulation and neurofibrillary tangle formation may help develop effective treatment options in the future. Alternative pharmacological approaches are currently being evaluated in ongoing phase 1 and phase 2 studies. Nevertheless, a lack of approved pharmacotherapeutic options has led to specific interventions that focus on patient education and life-style related factors receiving increasing attention. Keywords: Mild cognitive impairment, Alzheimer’s Dementia, Clinical Trials, Treatment

Long-Term Observation of a Multicomponent Cognitive Intervention in Mild Cognitive Impairment

Recent studies demonstrated benefits of cognitive intervention in mild cognitive impairment (MCI), but few studies have determined long-term effects on cognition, conversion rate to Alzheimer's disease, and the role of early intervention. A 6-month multicomponent cognitive group intervention was applied in participants with single- or multiple-domain amnestic MCI (defined according to Petersen's criteria). One group (n = 12) received the intervention at the beginning of the study period and was compared with an active control group (n = 12) who received it after an 8-month time lag. Follow-up assessments were conducted at 15 and 28 months (study period was August 2007-December 2009). The primary outcome was change in cognitive function as determined by changes in scores on the Mini-Mental State Examination and the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), and the secondary outcomes were change in specific cognitive and noncognitive functions and conversion to Alzheimer's disease (according to DSM-IV/NINCDS-ADRDA criteria and NAI-AA criteria for probable Alzheimer's dementia with increased level of certainty). Eighteen participants completed the study after 28 months. Long-term data revealed a stable intervention effect on the primary outcome ADAS-cog in the early-intervention group (P = .024). The participants in the later-intervention (control) group appeared to benefit to a lesser extent from the cognitive intervention compared to those who received it earlier. Only participants in the later-intervention group (6 of 12) converted to Alzheimer's disease during the 28-month study period. Benefits of our 6-month cognitive intervention on global cognitive status appear to be preserved over extended follow-up periods. Early cognitive intervention may delay conversion to Alzheimer's disease. Findings in a small sample encourage the use of the intervention in larger-scale studies. ClinicalTrials.gov identifier: NCT00544856.

The economics of mild cognitive impairment

Individuals with amnestic mild cognitive impairment (MCI) are at elevated risk of developing Alzheimer’s disease (AD). Although the economic burden of AD itself is well recognized, little is known about the direct and indirect costs associated with MCI before the onset of AD. Insufficient data on the economic impact of MCI as well as other gaps in the knowledge base (such as estimates of MCI progression rates and factors that drive MCI-related costs) present challenges to understanding the burden of MCI and to modeling the cost-effectiveness of potential MCI interventions. Initiating treatment and care management in the MCI phase could improve the health and well-being of patients and caregivers and possibly offset certain costs. Future economic analyses should incorporate new data, as they become available, from patient registries and linked administrative claims and electronic medical records to better characterize the cost consequences of MCI detection and management. Such analyses should help payers, providers, and policy makers make more informed decisions about the costs and benefits of new tests, treatments, and other management strategies for the condition.

English

Vascular cognitive impairment refers to the risk factors derived from blood vessels caused by a variety of levels and types of cognitive impairment, such as vascular mild cognitive impairment, vascular dementia and mixed dementia. Using acupuncture for mild cognitive impairment leukoaraiosis has impacts on the functional magnetic resonance. To know the neurotransmitter changes before and after acupuncture intervention in mild cognitive impairment with the functional magnetic resonance brain, laboratory for music and communication in infancy (LAMCI) cases (23), and 13 normal subjects (control group) cases were observed. Acupuncture treatment and the natural process group were observed for 3 months, respectively. Neuropsychological evaluation and magnetic resonance spectroscopy check were executed at the beginning and end of each day. Neuropsychological assessment includes mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA), magnetic resonance imaging (MRI), spectroscopy N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and myoinositol (MI)/Cr. The results showed that acupuncture can be used as an effective means of intervention for mild cognitive impairment leukoaraiosis, which can reduce activated brain regions in order to raise the efficiency of the task when stimulation is processed.   Key words: Acupuncture, leukoaraiosis, mild cognitive impairment, functional magnetic resonance, magnetic resonance spectroscopy.

Mild Cognitive Deficits and Everyday Functioning Among Older Adults in the Community: The Monongahela-Youghiogheny Healthy Aging Team Study

: A key component of successful aging is the ability to independently perform instrumental activities of daily living (IADL). We examined the ability to perform multiple IADL tasks in relation to mild cognitive impairment (MCI) defined on purely neuropsychological grounds. : Cross-sectional study. : Population-based cohort in southwestern Pennsylvania. : One thousand seven hundred thirty-seven community-dwelling adults age 65 years and older. : Classification of MCI based on performance with reference to norms in the cognitive domains of memory, language, attention, executive, and visuospatial functions. The ability to perform seven IADL tasks (traveling, shopping, preparing meals, doing housework, taking medications, handling personal finances, and using the telephone) as assessed by the Older Americans Resources and Services scale. : Those with cognitively defined MCI were more likely to be dependent in at least one IADL task, as well as in each individual IADL task, than cognitively normal participants. Better memory and executive functioning were associated with lower odds of IADL dependence in MCI. Across the subtypes of MCI, those with the multiple-domain amnestic subtype were most likely to be dependent in all IADL tasks, with better executive functioning associated with lower risk of dependence in select IADL tasks in this group. : Mild impairment in cognition is associated with difficulty performing IADL tasks at the population level. Understanding these associations may help improve prediction of the outcomes of MCI. It may also allow appropriate targeting of cognitive interventions in MCI to potentially help preserve functional independence.

Using Markov model to cost-effectiveness analysis of traditional Chinese medicine interference

Mild cognitive impairment (MCI) is the transition state between normal aging and AD. There are better detection and treatment methods to screen a population of patients with MCI. Through intervention, the probability of MCI conversion to AD can be significantly reduced. This paper first introduces the concept of cost-effectiveness analysis, reconsiders the concept of cost for the particularity of MCI, and uses QALY to evaluate the health effects of the quality of life. Then measure the health quality of life of elderly MCI population, and use Markov model to study the cost of intervention with traditional Chinese medicine-effectiveness analysis. Finally, according to the QALY measure and CEA results, we draw the conclusion that it's helpful to get early intervention in MCI.