Management Of Mild Cognitive Impairment Research Articles

Use of mild cognitive impairment and prodromal AD/MCI due to AD in clinical care: a European survey

IntroductionThe diagnosis of mild cognitive impairment (MCI) refers to cognitive impairment not meeting dementia criteria. A survey among members of the American Association of Neurology (AAN) showed that MCI was considered a useful diagnosis. Recently, research criteria have been proposed for the diagnosis of Alzheimer’s disease (AD) in MCI based on AD biomarkers (prodromal AD/MCI due to AD). The aim of this study was to investigate the attitudes of clinicians in Europe on the clinical utility of MCI and prodromal AD/MCI due to AD criteria. We also investigated whether the prodromal AD/MCI due to AD criteria impacted management of MCI patients.MethodsAn online survey was performed in 2015 among 102 members of the European Academy of Neurology (EAN) and the European Alzheimer’s Disease Consortium (EADC). Questions were asked on how often criteria were used, how they were operationalized, how they changed patient management, and what were considered advantages and limitations of MCI and prodromal AD/MCI due to AD. The questionnaire consisted of 47 questions scored on a Likert scale.ResultsAlmost all respondents (92%) used the MCI diagnosis in clinical practice. Over 80% of the EAN/EADC respondents found a MCI diagnosis useful because it helped to label the cognitive problem, involve patients in planning for the future, and start risk reduction activities. These findings were similar to those reported in the AAN survey. Research criteria for prodromal AD/MCI due to AD were used by 68% of the EAN/EADC respondents. The most common reasons to use the criteria were increased certainty of diagnosis (86%), increased possibilities to provide counseling (51%), facilitation of follow-up planning (48%), start of medical intervention (49%), and response to patients’ wish for a diagnosis (41%). Over 70% of the physicians considered that a diagnosis of prodromal AD/MCI due to AD had an added value over the MCI diagnosis.ConclusionsThe diagnostic criteria of MCI and prodromal AD/MCI due to AD are commonly used among EAN/EADC members. The prodromal AD/MCI due to AD were considered clinically useful and impacted patient management and communication.

Relationships between sleep quality, depressive symptoms and MCI diagnosis: A path analysis

BackgroundThis study examined the complex relationships between sleep quality, depressive symptoms, and cognitive decline in older adults. We hypothesised that older age, lower education and greater medical comorbidities would each be associated with increased mild cognitive impairment (MCI) diagnosis risk through indirect effects via poorer sleep quality, and greater depressive symptomology. Methods540 adults 44 years and over were recruited at the Brain and Mind Centre, Sydney, Australia. Participants underwent comprehensive psychiatric, neuropsychological, and medical assessment. Subjective sleep quality, current depressive symptomatology, and current medical burden were assessed. ResultsThere were significant indirect effects of each of age, comorbidities and education, that operated via both sleep and depression. Younger age, greater comorbidities and fewer years’ education each predicted greater chance of MCI diagnosis via poorer sleep and in turn higher depressive symptomatology. Additionally, there was a significant direct effect of older age on MCI. LimitationsThe current study is cross-sectional and cannot determine whether poorer sleep quality and greater depressive symptomatology precede or arise as a result of the onset of cognitive decline in later-life. A longitudinal design may allow further explication of these relationships. ConclusionsBoth sleep and depression are linked with cognitive decline in older adults, with sleep disturbance appearing to predict depressive symptoms. These findings have implications for the management of MCI. Both greater depression symptomatology and sleep disturbance were shown to predict the risk of MCI diagnosis, with this effect strongest in those that are younger. Improved early detection and treatment of sleep problems in older adults may help prevent depressive symptom manifestation or exacerbation, in turn potentially reducing the risk of subsequent cognitive decline.

Symptom Clusters of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Their Comparative Risks of Dementia: A Cohort Study of 8530 Older Persons

ObjectivesNeuropsychiatric symptoms (NPS) have been recognized to increase the risk of dementia among individuals with mild cognitive impairment (MCI). However, it is unclear whether the risk is shared across the various NPS or driven primarily by selected few symptoms. This study sought to provide confirmatory evidence on the comparative risk of dementia across the various NPS in MCI. DesignCohort study (median follow-up 4.0 years; interquartile range 2.1–6.4 years). SettingAlzheimer's Disease Centers across the United States. ParticipantsParticipants ≥60 years of age and diagnosed with MCI at baseline (n = 8530). MeasuresParticipants completed the Neuropsychiatric Inventory–Questionnaire at baseline and were followed up almost annually for incident dementia. Symptom clusters of NPS, as identified from confirmatory factor analyses, were included in Cox regression to investigate their comparative risks of dementia. ResultsThree symptom clusters of NPS were identified among participants with MCI, namely hyperactivity, affective, and psychotic symptoms. The risk of dementia was present among participants with affective symptoms [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.4–1.9] and psychotic symptoms (HR 1.6, 95% CI 1.2–2.2), but not among those with hyperactivity symptoms (HR 1.1, 95% CI 0.9–1.3). The risk was higher when affective symptoms and psychotic symptoms co-occurred (HR 2.5, 95% CI 2.0–3.2), with one-half of the participants in this group developing dementia within 2.7 years of follow-up. Conclusions and ImplicationsThe findings illustrate the potential usefulness of NPS as a convenient prognostic tool in the clinical management of MCI. They also suggest the need for future research to focus on affective/psychotic symptoms in MCI when studying the neurobiological links between NPS and neurodegenerative processes.

Mild cognitive impairment in primary care: a clinical review

Dementia is projected to become a global health priority but often not diagnosed in its earlier preclinical stage which is mild cognitive impairment (MCI). MCI is generally referred as a...

Effects of exercise interventions for specific cognitive domains in old adults with mild cognitive impairment: A protocol of subgroup meta-analysis of randomized controlled trials.

Background:Mild cognitive impairment (MCI) is the clinical prognosis that leads to dementia. Early intervention of MCI is critical to protect against dementia. Exercise intervention has gained popularity for the management of MCI. Most current studies have focused only on improvements made by exercise interventions on the global/general cognitive function and/or a specific cognitive function. However, no studies have been performed on a subgroup analysis of the effects of exercise interventions on different cognitive domains of the elderly with MCI. The exploration of this issue will help to clarify the influence and through a preliminary analysis identify the level of influence of exercise interventions on particular cognitive domains, and it will provide the theoretical framework for the construction of precise exercise intervention strategies for MCI patients.Methods:A systematic review of electronic databases (MEDLINE, Embase, The Cochrane Library, Web of Science, CNKI, the Wan Fang Database, and CBM), supplemented by expert contact, reference and citation checking, and gray literature searches have been conducted. There is no restriction on language or publication status. Cochrane Handbook for Systematic Reviews of Interventions and add another 3 items according to PEDpro, including “the type of statistical analyses used (true intention-to-treat vs other),” “eligibility criteria,” and “baseline comparability,” are used to assess the risk of bias. Primary outcomes of interest are standardized measurements of executive functions, memory, language, processing speed, and attention. If possible, we conduct a meta-analysis to synthesize the evidence for each outcome.Results:This study will provide a high-quality synthesis of current evidence of exercise for MCI patients.Conclusion:The conclusion of this systematic review will provide evidence to judge whether exercise is an effective intervention for patient with MCI and preliminary ranking of the effects of exercise on specific cognitive domains.Prospero registration number:CRD42018093902

Mild Cognitive Impairment in Clinical Practice: A Review Article.

The spectrum of cognitive decline in the elderly ranges from what can be classified as normal cognitive decline with aging to subjective cognitive impairment to mild cognitive impairment (MCI) to dementia. This article reviewed the up-to-date evidence of MCI including the diagnostic criteria of MCI due to Alzheimer's disease, vascular cognitive impairment and MCI due to Parkinson disease, management and preventive intervention of MCI. There are various etiologies of MCI, and a large number of studies have been conducted to ascertain the practical modalities of preserving cognition in predementia stages. Lifestyle modification, such as aerobic exercise, is an approved modality to preserve cognitive ability and decrease the rate of progression to dementia, as well as being recommended for frailty prevention.

ACETYLCHOLINESTERASE INHIBITOR THERAPY IN MILD COGNITIVE IMPAIRMENT: YES OR NO?

Acetylcholinesterase inhibitors (AChEI) are frequently prescribed for the symptomatic treatment of mild cognitive impairment (MCI) though not approved by the Food and Drug Administration for this indication. AChEIs use, genetic, biological and neurological outcomes data were collected during the three phases of the Alzheimer Disease Neuroimaging Initiative (ADNI1, ADNIGO, ADNI2). Linear regression models were used to compare the treatment effect - on changes in MMSE and CDR-SB scores during a time course of 2 years. MCI subjects treated with AChEIs showed a greater decline in MMSE and a greater rise in CDR-SB after 2-year compared to non-treated ones. Examining the data further, we found a significant association between treatment duration and AChEIs on MMSE decline in the treated group. A similar association between duration of therapy and increased CDR-SB was observed. Our findings thus indicate a faster decline in MMSE and faster rise CDR-SB scores in subjects treated with AChEIs compared to the untreated group. We then stratified by APOE4 genotypes and found a trend for steeper cognitive changes in treated APOE4 carriers compared to treated non-carriers. In a sub-group of MCI treated subjects, we also found that cerebrospinal fluid AD biomarkers (i.e. amyloid-beta and p-tau) were significantly different at baseline compared to the non-treated MCIs. This indicates that the worsening in cognitive decline observed in the treatment group may not be only associated with the use of AChEIs but also due to the natural history of the disease progression. Our findings have an important implication for MCI management. Thus, it opens up the discussion of the off-label use of AChEIs in MCI and the evaluation of the risks versus the benefits of such treatment approach if there is no alternative to AChEIs.

Depression and mild cognitive impairment (MCI) among elderly patients with type 2 diabetes mellitus in Pakistan: possible determinants

This descriptive, cross-sectional, questionnaire-based study was designed to assess the extent of depression and mild cognitive impairment (MCI) and their possible determinants among the elderly with type 2 diabetes mellitus in Pakistan. The study was carried out at the diabetes outpatient clinics of two tertiary care hospitals in Lahore, district of Punjab in Pakistan using convenience sampling techniques between December 1, 2015 and February 28, 2016. All consenting patients were interviewed to complete the Geriatric Depression Scale (GDS-15) and the Montreal Cognitive Assessment (MoCA). Standard scoring schemes were used for these scales. Multiple logistic regression analysis was carried out to identify any statistically significant variables from the univariate analysis, to segregate independent factors. A p value < .05 was taken as the mark of statistical significance for tests. A total of 490 elderly patients with type 2 diabetes mellitus were approached. Of those, 400 patients agreed to participate, resulting in a response rate of 81.6%. GDS-15 scores suggest that only 130 (32.5%) patients were not depressed to some degree. High HbA1C and MCI were significant predictors of depression. MoCA scores indicated that 269 (67.3%) patients had MCI, and depression was the only predictor of MCI among the study patients. The implications of the findings include the need by healthcare providers to consider the assessment and management of depression and MCI as part of diabetes treatment protocols so that elderly patients can achieve positive diabetes outcomes and have improved health-related quality of life.

Deleterious Effect of Butyrylcholinesterase K-Variant in Donepezil Treatment of Mild Cognitive Impairment.

Donepezil is an acetylcholinesterase inhibitor frequently prescribed for the treatment of mild cognitive impairment (MCI) though not approved by the Food and Drug Administration for this indication. In Alzheimer's disease, butyrylcholinesterase (BChE) activity increases with disease progression and may replace acetylcholinesterase function. The most frequent polymorphism of BChE is the K-variant, which is associated with lower acetylcholine-hydrolyzing activity. BChE-K polymorphism has been studied in Alzheimer's disease progression and donepezil therapy, and has led to contradictory results. To determine whether BChE-K genotype predicts response to donepezil in MCI. We examined the association between BChE-K genotype and changes in cognitive function using the data collected during the ADCS vitamin E/donepezil clinical trial in MCI. We found significant interactions between BChE-K genotype and the duration of donepezil treatment, with increased changes in MMSE and CDR-SB scores compared to the common allele in MCI subjects treated during the 3-year trial. We found faster MMSE decline and CDR-SB rise in BChE-K homozygous individuals treated with donepezil compared to the untreated. We observed similar interactions between BChE-K genotype and steeper changes in MMSE and CDR-SB scores in APOE4 carriers treated with donepezil compared to controls. BChE-K polymorphisms are associated with deleterious changes in cognitive decline in MCI patients treated with donepezil for 3 years. This indicates that BChE-K genotyping should be performed to help identify subsets of subjects at risk for donepezil therapy, like those carrying APOE4. BChE-K and APOE4 carriers should not be prescribed off-label donepezil therapy for MCI management.

Efficacy and safety assessment of acupuncture and nimodipine to treat mild cognitive impairment after cerebral infarction: a randomized controlled trial.

BackgroundCerebral infarction frequently leads to mild cognitive impairment (MCI). Prompt management of MCI can prevent vascular dementia and improve patient outcome. This single center randomized controlled trial aims to investigate the efficacy and safety of acupuncture and nimodipine to treat post-cerebral infarction MCI.MethodsA total of 126 Chinese patients with post-cerebral infarction MCI recruited from the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine between April 2013 and June 2014 were randomized at 1:1: 1 ratio into nimodipine alone (30 mg/time and 3 times daily), acupuncture alone (30 min/time, 6 times/week), and nimodipine + acupuncture groups. The treatments were 3 months. Cognitive function was evaluated using Montreal Cognitive Assessment (MoCA) scale at enrollment interview, at the end of 3-month therapy, and at the post-treatment 3-month follow-up.ResultsThe per-protocol set included 39, 40, and 40 patients from nimodipine alone, acupuncture alone, and the combination group, respectively, was analyzed. Intra-group comparison revealed that MoCA score at the follow-up improved significantly by 15.8 ± 10.9, 20.9 ± 13.8 %, and 30.2 ± 19.7 % compared with the baseline MoCA for nimodipine alone, acupuncture alone, and the combination group, respectively. Inter-group comparison demonstrated that the combination therapy improved MoCA score (5.5 ± 2.2) at significantly higher extent than nimodipine alone (3.1 ± 1.8) and acupuncture alone (4.3 ± 2.3) at the follow-up (All P < 0.05), and significantly higher proportion of patients in acupuncture alone group (80 %) and the combination therapy group (90 %) than in nimodipine alone group (56.4 %) showed ≥12 % MoCA score improvement compared with the baseline MoCA (All P < 0.05). No adverse event was reported during the study.ConclusionAcupuncture may be used as an additional therapy to conventional pharmacological treatment to further improve the clinical outcomes of patients with post-cerebral infarction MCI.Trial registrationThe study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/, Unique Identifier: ChiCTR-IOR-15007366). The date of registration is November 4, 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1337-0) contains supplementary material, which is available to authorized users.

Ayurvedic Management of Mild Cognitive Impairment

Life expectancy has increased as a result of advancement in medical science. As a result the prortion of elderly in the population is also greater than ever and there is a need to tackle their problems. Mild Cognitive Impairment (MCI) is one of the most common clinical manifestations af- fecting the elderly population. MCI is a term used to describe cognitive decline of thinking, memory and reasoning. This is an transitional stage between the cognitive decline of normal ageing and the more serious decline in dementia. Neurons fail to establish connections in appropriate time and when insuffi- ciently stimulated by nootropic factors, they die. This gradual- ly leads to mild cognitive impairment, as ageing occurs. Ac- cording to recent published works on cognition and dementia, 2/3 rd of all cases who are diagnosed with MCI have memory loss, more pronounced than thinking and reasoning. Timely intervention is awfully important in these cases as they are at a high risk of developing dementia. According to Sarangadhara Acharya, medha (grasping and retention power) deteriorates after the fourth decade of life and this may be considered as a warning signal for further smrti (memory) and buddhi (intellect) deterioration, in the successive years. Ayurveda has a major role to play in this arena. Rasaayana, Panchakarma therapy, drugs like guduchi, aswagandha,brahmi and the like, including various ghritas have proven effects in cognitive domains of psychological wellbeing. Further, giving constant mental stimulations through brain games which is mentioned through the concept of Buddhimedhakara gana, along with panchakarma meas- ures, bring significant results in all domains of cognition. Here is an attempt to discuss the pathogenesis and preven- tive aspects of cognitive deficits with special reference to de- mentia and MCI. Nootropic drugs, neuro rehabilitation and neuroplasticity are the three approaches which are analyzed in the purview of Ayurvedic concept and are suggested as tech- niques for the management and prevention of MCI.

The diagnosis and management of mild cognitive impairment: a clinical review.

Cognitive decline is a common and feared aspect of aging. Mild cognitive impairment (MCI) is defined as the symptomatic predementia stage on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living. To present evidence on the diagnosis, treatment, and prognosis of MCI and to provide physicians with an evidence-based framework for caring for older patients with MCI and their caregivers. We searched PubMed for English-language articles in peer-reviewed journals and the Cochrane Library database from inception through July 2014. Relevant references from retrieved articles were also evaluated. The prevalence of MCI in adults aged 65 years and older is 10% to 20%; risk increases with age and men appear to be at higher risk than women. In older patients with MCI, clinicians should consider depression, polypharmacy, and uncontrolled cardiovascular risk factors, all of which may increase risk for cognitive impairment and other negative outcomes. Currently, no medications have proven effective for MCI; treatments and interventions should be aimed at reducing cardiovascular risk factors and prevention of stroke. Aerobic exercise, mental activity, and social engagement may help decrease risk of further cognitive decline. Although patients with MCI are at greater risk for developing dementia compared with the general population, there is currently substantial variation in risk estimates (from <5% to 20% annual conversion rates), depending on the population studied. Current research targets improving early detection and treatment of MCI, particularly in patients at high risk for progression to dementia. Cognitive decline and MCI have important implications for patients and their families and will require that primary care clinicians be skilled in identifying and managing this common disorder as the number of older adults increases in coming decades. Current evidence supports aerobic exercise, mental activity, and cardiovascular risk factor control in patients with MCI.

Mild Cognitive Impairment: A Brief Review and Suggested Clinical Algorithm.

Mild cognitive impairment (MCI) is a dynamic state between normal cognition and dementia, where interventions can be taken to stop or delay the progression to dementia. It is broadly of 2 types-amnestic, where memory loss is the chief concern and nonamnestic, where it is not. One variant of nonamnestic, dysexecutive, being more prevalent is sometimes known as a separate subtype by itself. Diagnosis of MCI is mostly clinical and is aided by various scales and neuropsychological testing. Functional imaging studies help in early detection and is superior to biomarkers or structural magnetic resonance imaging. Although there is no evidence supporting any pharmacological intervention, cognitive rehabilitation, memory training, and caregiver support play a strong role in limiting and sometimes reversing the ongoing cognitive decline. As the spectrum of MCI is heterogeneous, making the right diagnosis can be a challenging; hence, we need a systematic yet cost-effective algorithm for the timely management of MCI.

The Effect of Mild Cognitive Impairment Management Program on Traditional Korean Medicine in a Public Health Center

Objectives: The aim of this study was to evaluate the effect of a mild cognitive impairment (MCI) management program on traditional Korean medicine in a public health center. Methods: In order to examine the effect of the MCI management program, we investigated MCI patients who participated in the program. MCI patients were treated with Jodeung-san (JDS) or Dangguijagyag-san (DGJYS) for 6 weeks. Mini Mental State Examination-Dementia Screening (MMSE-DS), Geriatric Quality of Life-Dementia (GQOL-D), Geriatric Depression Scale in Korea (GDS-K), and biochemical examination of blood were conducted at intervals of 6 weeks. A satisfaction survey was collected after this program. Results: MMSE-DS mean score increased significantly, by 4.09 (p=0.000) in the JDS group and by 4.15 (p=0.000) in the DGJYS group. GQOL-D mean score also increased significantly, by 5.90 (p=0.000) in the JDS group and by 5.07 (p=0.000) in the DGJYS group. GDS-K mean score decreased significantly, by 10.63 (p=0.000) in the JDS group and by 9.69 (p=0.000) in the DGJYS group. MMSE-DS, GDS-K and GQOL-D scores were not significantly different between the JDS and DGJYS groups. All of the participants were satisfied with the program, and 90% of the participants expressed a high intention to participate in the program again. Conclusions: Both Jodeung-san and Dangguijagyag-san treatment showed improvement on cognitive function, depression and quality of life in this program. Additional studies with more subjects will be required to prove credibility and validity more clearly. Keywords: Jodeung-san, Dangguijagyag-san, MCI, MMSE-DS, GDS-K, GQOL-D

Normal Cognitive Aging and Mild Cognitive Impairment: Drawing the Fine Line

Mild cognitive impairment (MCI) is a transitional diagnostic category between normal cognitive aging and dementia. Speech-language pathologists (SLPs) have a role in the management of MCI, particularly the assessment and treatment of cognitive-communicative impairments related to MCI. The difficulty lies in distinguishing between normal cognitive aging and pathological aging. SLPs will need to be equipped with knowledge regarding the neurobiological, cognitive, and cognitive-communicative changes occurring in both normal and pathological aging, specifically the alterations arising in MCI.

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.

Distinct laterality alterations distinguish mild cognitive impairment and Alzheimer's disease from healthy aging: statistical parametric mapping with high resolution MRI.

Laterality of human brain varies under healthy aging and diseased conditions. The alterations in hemispheric asymmetry may embed distinct biomarkers linked to the disease dynamics. Statistical parametric mapping based on high-resolution magnetic resonance imaging (MRI) and image processing techniques have allowed automated characterization of morphological features across the entire brain. In this study, 149 subjects grouped in healthy young, healthy elderly, mild cognitive impairment (MCI), and Alzheimer's disease (AD) were investigated using multivariate analysis for regional cerebral laterality indexed by surface area, curvature index, cortical thickness, and subjacent white matter volume measured on high-resolution MR images. Asymmetry alteration of MCI and AD were characterized by marked region-specific reduction, while healthy elderly featured a distinct laterality shift in the limbic system in addition to regional asymmetry loss. Lack of the laterality shift in limbic system and early loss of asymmetry in entorhinal cortex may be biomarkers to identify preclinical AD among other dementia. Multivariate analysis of hemispheric asymmetry may provide information helpful for monitoring the disease progress and improving the management of MCI and AD.

Are Guidelines Needed for the Diagnosis and Management of Incipient Alzheimer's Disease and Mild Cognitive Impairment?

Current research is aiming to push the boundaries of the point at which a diagnosis of Alzheimer Disease (AD) can be made. Clinical syndromes such as Mild Cognitive Impairment (MCI) and various clinical and biological markers of AD may help to identify people in the early stage of AD, before a full dementia syndrome is present. In the first part of this paper, we discuss whether MCI represents incipient AD, and examine some of the methods currently used in research to identify AD patients in the preclinical phase. In the second part, we discuss whether specific guidelines are needed for the diagnosis and management of MCI and incipient AD, and consider the potential impact of this on clinical practice and public health from the perspective of patients, caregivers, and healthcare providers.

Buying time: management of mild cognitive impairment and early dementia

Early initiation of Alzheimer's disease (AD) treatment is advantageous because it can potentially keep patients in milder stages of the disease longer than delayed treatment. Early initiation of cholinesterase inhibitor therapy is an effective intervention for mild AD. Therefore, it is critical to identify and monitor patients who are at risk for AD and to initiate treatment once AD is diagnosed. A new diagnostic category, mild cognitive impairment (MCI), has been evolving to identify patients who demonstrate objective memory impairment but have essentially intact function or only limited functional impairment and do not meet diagnostic criteria for dementia. The amnestic subtype of this condition is associated with a high risk of AD – 16% of amnestic MCI patients convert to AD each year compared with 1% to 3% of normal elders. A recent three-year study found that patients with amnestic MCI who were treated with donepezil had a significantly reduced likelihood of progression to dementia in the first 12 months of treatment. The effect of donepezil in delaying onset of dementia was supported by significant differences favoring donepezil in the Mini-mental State Examination, the Clinical Dementia Rating-Sum of the Boxes, the Global Deterioration Scale, and the modified Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-Cog) over the first 18 months of treatment. A previous study evaluated the effects of donepezil on memory and cognition in patients with MCI. Although donepezil had no significant effect on memory as measured by the New York University Paragraph Recall Test, it significantly improved scores on the modified ADAS-Cog. Donepezil therefore shows promise in this patient population and warrants further investigation using extended study durations and refined outcome measures.

No alteration in the PFA-100 in vitro bleeding time induced by the Ginkgo biloba special extract, EGb 761, in elderly patients with mild cognitive impairment

EGb 761 is widely used in the management of mild cognitive impairment in the elderly population. Elucidation of the effects of EGb 761 on primary haemostasis via PFA-100 could represent an important step for better understanding of the haemostatic safety of EGb 761. The purpose of this prospective study is to assess the effects of Ginkgo biloba special extract, EGb 761, on PFA-100 in vitro bleeding time in elderly patients with mild cognitive impairment. A total of 40 elderly patients aged 65-79 years who were referred for geriatric assessment and who were diagnosed as having mild cognitive impairment were included. Patients were started on 80 mg EGb-761 three times daily. The complete set of PFA-100 in vitro bleeding time and coagulation parameters including prothrombin time, activated partial thromboplastin time and International Normalized Ratio were assessed before and on the seventh day of treatment with EGb 761. There was no statistically significant prolongation in PFA-100 in vitro bleeding time or coagulation parameters in patients receiving EGb 761 after 7 days. The data about the safety of EGb 761 from the point of primary haemostasis in our elderly patient population with mild cognitive impairment casts hope for the future management of this 'difficult-to-treat' population with the promising Ginkgo extracts.