Mild Cognitive Impairment Flashcards
What is the definition of mild cognitive impairment?
Objective evidence of impairment in 1 or more cognitive domains on testing with preserved/minimal impact on IADLs
What are the subtypes of MCI?
Amnestic
Non amnestic
Single vs. multiple domains
What impacts prevalence of MCI?
Increase with age
Increase with lower education level
What is the progression of MCI?
Can revert to normal (14-38%)
Can remain stable
Can progress to dementia (up to 65%)
What is the rate of progression of MCI to dementia per year?
10% per year
What are risk factors for progression of MCI to AD?
- Older age
- Less education
- Stroke/cerebrovascular disease
- Diabetes
- HTN
- AF
- Amnestic subtype
- APOE4
- Slower gait speed/dual task gait
- Medial temporal lobe atrophy
- CSF biomarkers: total tau, amyloid beta
How often should you follow up patient with MCI?
Follow annually
Serial assessments over time to assess for change in cognition
What cognitive testing should you use for MCI?
MOCA more sensitive in detecting MCI than MMSE, especially if MMSE 24+/30
MMSE low Sn and Sp for predicting who could convert
Others
1. Brief cognitive assessment tool
2. Dual task gait
What are pharmacologic therapies for MCI?
None presently
CHEI off label
Anti-amyloid drugs but not yet approved in Canada
- Wean from contributing meds
- Tx modifiable risk factors
- BP management (no evidence)
- Statin (no evidence)
- Antiplatelet therapy
- Anticoagulation for AF
What are non-pharmacologic recommendations for MCI?
- Smoking cessation
- Exercise 2x/week
- Aerobic
- Resistance training
- Mind body (Tai Chi) - Treat OSA with CPAP
- Optimize hearing
- Stop cognitively impairing meds
- Mediterranean diet/MIND diet
- Social stimulation
- Reduce/stop alcohol
Should you get imaging in patients with MCI?
Same indications as in dementia patients
MRI>CT
1. Onset in last 2 years
2. Unexpected/unexplained decline in cognition/fcuntion if known dementia
3. Recent/significant head trauma
4. Unexplained neuro signs on onset or evolution
5. Hx of cancer
6. Risk of intracranial bleeding
7. NPH symptoms
8. Significant vascular risk factors
What is subjective cognitive decline? What is the approach to dx and management?
Self perceived cognitive decline in cognitively normal person
- Get history and do testing
- Standard medical work up
- If collateral says no concerns = reassurance, no follow up
- If collateral corroborates = annual follow up
Inc risk for MCI and dementia
What is motoric cognitive impairment?
Subjective cognitive decline PLUS
Objective decline in motor function (slow gait)
Without dementia or mobility disability
Increased risk of dementia and falls
What is mild behavioural impairment?
Changes in behaviour or personality
Behaviours of sufficient severity
Not meeting criteria for another dementia syndrome
No concurrent psychiatric disorder
Start 50+ yo
5 domains of changes:
1. Decreased motivation (apathy)
2. Affective dysregulation (anxiety)
3. Impulse dyscontrol (disinhibition)
4. Social inappropriateness (lack of empathy)
5. Abnormal perception or thought content (hallucination, delusion)
What other management should you do with MCI patient?
- Cognitive training
- Learned strategies
- Wellness education - Long term planning (driving, finance, estate, advance directives)
- Assess behavioural/neuropsych and tx if needed
