Ger 4 Cognitive Impairment

Question 1

What is mild cognitive impairment?

Answer 1

An intermediate state of cognitive function between the changes seen in normal aging and those fulfilling the criteria for dementia and often Alzheimer’s disease

Question 2

This is a decline in cognitive function beyond that associated with typical aging, but not as severe of a decline as seen in dementia or Alzheimers

Answer 2

Mild Cognitive Impairment (MCI)

Question 3

When in neuropsychological testing used and what is it helpful for?

Answer 3

In particularly subtle cases, neuropsychological testing may be helpful to distinguish mild cases of MCI from normal aging (This is the Short Test of Mental Status and the Montreal Cognitive Assessment)

Question 4

In mild cognitive impairment, is the decline recognized and why whom?

Answer 4

It is recognized by those experiencing it and occasionally by those around them

Question 5

What is the prevalence (%) of mild cognitive impairment?

Answer 5

10-20% in persons older than 65 years of age

Question 6

In one study listed, what was the % of patients between 70-89 without dementia who had (1) amnesic MCI and (2) nonamnestic MCI?

Answer 6

1. 11.1%

2. 4.9%

Question 7

What are persons with MCI at an increased risk for developing?

Answer 7

Dementia (significantly increased risk

Question 8

What is the % progression to dementia in patients with MCI in community-based populations?

Answer 8

5-10%

Question 9

What is the % progression to dementia in patients with MCI in specialty clinics

Answer 9

10-15% (compare to 1-2% in the general population)

Question 10

What is the general rate of progression (to dementia) among those with a diagnosis of MCI?

Answer 10

~10% per year

Question 11

7 Factors that predict a more rapid progression to dementia?

Answer 11

1. Greater impairment at base line (ie. Degree of cognitive impairment at presentation)
2. Carriers of the apolipoprotein (APOE) 4 allele
3. MRI showing volumetric measurement of the hippocampus that fell at or below the 25th % for age and sex (used for amnestic MCI)
4. MRI showing larger ventricular volumes
5. Hypometabolism in the temporal & parietal regions of the brain on 18FDG-PET may indicate an increased risk of progression from MCI to Alzheimer’s
6. Low levels of β-amyloid peptide 42 (Aβ42) & elevated levels of tau protein in the CSF indicate an increased risk of progression from MCI to Alzheimer’s (Similar risk of progression is seen with a low ratio of Aβ42 to tau in the CSF)
7. Amyloid plaques in the brain (identified using PET scans) suggest a more rapid progression to Alzheimer’s disease

Question 12

Why should clinicians avoid labeling MCI patients as having early Alzheimer’s disease or any similar names?

Answer 12

Because the precise outcome in MCI is not certain (despite MCI being an abnormal condition)

Question 13

What s dementia?

Answer 13

When cognitive effects are affecting daily functioning to the extent that there is loss of independence in the community

Question 14

How do you make the diagnosis of dementia?

Answer 14

• By careful history taking
• A diagnosis of dementia can be supported with the use of instruments such as the Functional Activities Questionnaire, which characterizes impairment in function, that is within the range of dementia

Question 15

What is the prevalence of dementia?

Answer 15

1-2% per year in the US

Question 16

What happens to cognition in normal aging?

Answer 16

Most people undergo gradual cognitive decline, typically with regard to memory, over their life span. This is usually a minor decline and doesn’t compromise the ability to function

Question 17

What can be done to help distinguish particularly mild cases of MCI from normal aging?

Answer 17

Neuropsychological testing

Question 18

Are there any medications indicated for the treatment of MCI?

Answer 18

No…presently no medication intended for the treatment of MCI has been approved

Question 19

What did studies conclude about treatment of MCI with agents used for Alzheimer’s disease (high-dose vitamin E and donepezil)

Answer 19

No significant reduction in rates of progression to dementia (among patients with MCI who were treated with agents used to treat Alzheimer’s disease)

Question 20

What did the studies mentioned show about the use of donepezil?

Answer 20

One trial showed that donepezil significantly reduced the risk of progression to Alzheimer’s disease for the first 12 months (and for up to 24 months in the subgroup of patients who were carriers of APOE ε4)
*But had no significant effect on the risk of Alzheimer’s disease at 36 months

Question 21

What did the studies mentioned show about the use of High-dose Vitamin E?

Answer 21

Did not significantly reduce the risk of progression at any point

Question 22

What showed some evidence of potential benefit in MCI?

Answer 22

Cognitive rehabilitation (Has shown significant improvement in cognitive function at the end of training)

Question 23

What is included in cognitive rehabilitation?

Answer 23

1. Use of mnemonics
2. Association strategies
3. Computer-assisted training programs

Question 24

What is seen with the presence of CV risk factors in patients with MCI?

Answer 24

They have an increased risk of progression to dementia

Question 25

What was seen in the study looking at the benefit of a physical exercise program compared to baseline care and education in patients with subjective memory loss?

Answer 25

The exercise group had better cognitive function at 6 months, with some residual benefit noted at 18 months

Question 26

What are the 2 types of MCI?

Answer 26

1. Amnestic MCI

2. Nonamnestic MCI

Question 27

What is amnestic MCI?

Answer 27

Clinically significant memory impairment that doesn’t meet the criteria for dementia
–> Memory loss if the most significant feature in this sub-type and is more prominent that that seen in normal aging

Question 28

What is a description of patients with amnestic MCI and who are the symptoms obvious to?

Answer 28

• These individuals will forget important information that they previously would have remembered (appointment, telephone conversations, recent events that would normally interest them)
• Patients and families are aware of increasing forgetfulness, but it might not be apparent to casual observer)

Question 29

What happens to other cognitive functions and functional acitivities in amnestic MCI?

Answer 29

• Other cognitive capacities (executive function, use of langues, and visuospatial skills) are relatively preserved
• Functional activities are intact

Question 30

What % of patients that progress to dementia from amnestic MCI have clinical signs of Alzheimer’s disease?

Answer 30

More than 90%

Question 31

What is nonamnestic MCI characterized by?

Answer 31

A subtle decline in functions not related to memory, but rather affecting attention, use of language or visuospatial skills

Question 32

Which sub-type of MCI is more common?

Answer 32

Amnestic

Question 33

Is nonamnestic MCI related to Alzheimer’s?

Answer 33

NOPE…nonamnestic MCI may be the forerunner of dementias that are not related to Alzheimer’s
(Frontotemporal lobar degeneration or dementia with Lewy bodies)

Question 34

What are examples of things that can cause a reversible form of MCI?

Answer 34

• Depression

- S/E of medication

Question 35

Memory Impairment?

Answer 35

Amnestic MCI

Question 36

No Memory Impairment?

Answer 36

Nonamnestic MCI