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MCI (Assessment ( Differential diagnosis
Etiology
Treatment, …
MCI
Assessment
- Differential diagnosis
- Etiology
- Treatment
- Neuropsychological evaluation
- assessment of functional independence
- assessment of driving abilities
Early symptoms:
- early language symptoms = aphasic dementia
- early memory symptoms = temporal lobe involvement
-
- Changes in behavior or personality: apathy, disinhibition, perseveration
- 35–75% of patients with MCI endorse at least one
neuropsychiatric symptom
- depression/dysphoria, apathy, anxiety, and agitation
- poor concentration, inner
tension, pessimistic thoughts, lassitude, reduced sleep,
thoughts of death, inability to feel, and reduced
appetite
-
Cognitive impairment
- Petersen et al.’s original study (1999), the cut off score set to identify MCI was 1.5 SD below age norms
- The most recent consensus criteria notes that scores on cognitive tests for patients with MCI are typically 1–1.5 SD below the mean for age and education matched peers on culturally appropriate normative data
Important
• evaluation of cultural level (CRIq)
• evaluation of premorbid functioning (e.g., word reading)
• evaluation of the patient’s performance in all major cognitive domains
• Evaluation of mood (depression and anxiety symptom)
Subtypes
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-
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Nonamnesic MCI is characterized by a subtle decline in
functions not related to memory, affecting executive
functions, attention, use of language, or visuospatial skills.
- it's probably less common than the amnestic type
- forerunner of dementias that are not related to
AD
Within the a-MCI groups, two new subtypes
identified
-
WMHs Impairments in attentional/cognitive control processes critical for
working memory, which in turn give rise to episodic memory decline (aumenta il deficit mnemonico)
Neurocognitive deficits
patients who ultimately convert to Alzheimer’s disease is a decline in episodic learning and memory early in the disease process
-
Semantic knowledge
- a severe decline does not typically occur at the MCI stage, but poorer performance than controls
Attention domain
- MCI patients who ultimately convert to AD demonstrate poorer immediate serial recall and divided attention than their MCI counterparts who remain cognitively stable
Feedback
- cognitive impairments
- risk for converting to dementia
- areas of difficulty
- cognitive and personal strength
- context of developing compensatory strategies
What is
a decline in cognitive performance greater
than would be expected for the person’s
age but not sufficient to meet criteria for a
diagnosis of dementia
-
-
Pathophysiology
Using PIB (Pittsburgh compound B) the presence of beta-amyloid plaques is
- AD> MCI > normal cognition
- MCI converting to dementia > MCI not converting
Ventricular expansion faster in people with MCI years prior the emergence of clinical symptoms
- greater volume loss for those who develops AD
rivisited criteria
- some patients have a primary impairment in the
memory domain only,
- memory impairment in addition to other
domain impairment(s)
- others have impairments in single or multiple
nonmemory cognitive domains
Updated clinical diagnostic criteria
- Concern regarding change in cognition
- Impairment in one or more cognitive
domains
- Preservation of independence in functional
abilities
- Not demented
Etiology
- degenerative
- vascular
- metabolic
- traumatic
- psychiatric
- other (toxic factors, metabolic, medication side effects)
MCI to dementia
- a rate of progression from MCI to dementia of 12%
per year
- 10-19% to AD
- At a 6-year follow-up, approximately 80% of MCI
patients were reported to have progressed to
dementia
- patient with MCI diaagnosis have 3 times greater risk of developping AD
- in clinical sample 41% remained stable and 17% return to normal cognitive status, due to metabolic abnormalities or substance use
PSEUDODEMENTIA
- Late-life depression can be accompanied by significant cognitive impairments
- cognitive symptoms of pseudodementia were assumed to be related to transient mood symptoms and therefore reversible with adequate psychiatric treatment
Neurofibrillary tangles are in limbic regions in all partecipants
Senile plaques affect all brain equally (except occipital)
The original criteria for MCI proposed by
Petersen et al. (1999):
- presence of memory complaint
- normal activities of daily living
- normal general cognitive function
- not demented
-
patients with na-MCI, with impairments in
nonmemory domains such as executive
function and visuospatial skills may be more
likely to convert to dementia with Lewy bodies