Mild Cognitive Impairment & Subjective Cognitive Decline

Question 1

Difference between SCD and MCI

Answer 1

• SCD: The patient thinks there are changes but we can’t see changes on the tests
• MCI: There is a subjective measure for it on a test, but it’s still liveable

Question 2

Continuum of decline

Answer 2

• The progression through the stages of cognitive decline and dementia
• It is not necessarily linear
• Not guarantee of progression to dementia
• Can be reversed before stage 3
• 10% convert from MCI to dementia annually

Question 3

Stage 1 of the continuum of decline

Answer 3

• No objective or subjective evidence for cognitive decline or impairment
• No behavioural symptoms

Question 4

Stage 2 of the continuum of decline

Answer 4

• Subjective or/and subtle objective cognitive decline
• Does not meet criteria for impairment
• Mild, recent onset behavioural symptoms could co-occur or be the predominant symptom

Question 5

Stage 3 of the continuum of decline

Answer 5

• Objective cognitive decline to the level of impairment and mild functional impairment possible, but independence preserved

Question 6

Stage 4 of the continuum of decline

Answer 6

• Mild dementia

Question 7

Stage 5 of the continuum of decline

Answer 7

• Moderate dementia

Question 8

Stage 6 of the continuum of decline

Answer 8

• Severe dementia

Question 9

Preclinical dementia

Answer 9

• Subjective cognitive decline
• Perceived deficits in cognition
• No objective deficits in cognition

Question 10

Aging to Mild Cognitive Impairment

Answer 10

• Declines that are more severe then what is expected for their age and education is considered mild cognitive impairment
• Changes in memory
• Changes in language
• Changes in visuospatial function
• Changes in attention or executive functioning

Question 11

Aging to MCI to Dementia

Answer 11

• Declines that are more severe then what is expected for their age and education is considered mild cognitive impairment
• Once the declines begin to impede on daily functioning the individual is diagnosed as having dementia

Question 12

What is MCI

Answer 12

• A condition in which someone experiences cognitive declines beyond what is expected in normal aging
• These declines are severe enough to be noticed by the person and loved ones
• The declines do not affect their ability to carry out everyday activities
• May or may not progress to develop dementia
• Can be reverted back but they have a higher chance of developing AD or dementia

Question 13

MCI risk factors

Answer 13

• Lower education
• APOE e4 status: allele that is a marker for AD/Dementia
• Increased age
• Family history of AD or dementia
• Conditions associated with cardiovascular disease

Question 14

MCI Misdiagnosed

Answer 14

• Sometimes MCI can be treated because it’s associated with some underlying condition
• Depression
• Metabolic causes
• Infection causes
• Sleep disorders
• Neurological disorders
• Perceived stress

Question 15

Cognitive Problems

Answer 15

• Changes in memory
• Changes in language
• Changes in visuospatial function
• Changes in attention/executive function
• Typically we use a cut off of 1.5SD below age and education matched means to show problems
• MoCA and other tests are what we use to evaluate this

Question 16

MCI Subtypes

Answer 16

• Cognitive tests will determine which subtype of MCI a person has
• Single domain: One cognitive domain impaired
• Multiple domain: Multiple cognitive domains impaired
• Amnestic MCI: Memory is mainly affected
• Non-amnestic MCI: Other cognitive functions are affected

Question 17

MCI Outcomes by subtype

Answer 17

• Amnestic MCI: AD, Vascular dementia
• Non-amnestic MCI: FTD, Lewy body dementia, Parkinson’s disease dementia

Question 18

Brain changes in MCI

Answer 18

• Atrophy: Typically see people with MCI having less brain volume compared to normal
• Amyloid buildup: Increases in amyloid deposits throughout the brain
• Tau buildup: Increases in tau, particularly in temporal lobe structure

Question 19

Progression of MCI to Dementia

Answer 19

• 10 to 15% of individuals with MCI develop dementia each year
• 1/3 of people with MCI develop dementia within 5 years

Question 20

Factors that increase risk of development from MCI to Dementia

Answer 20

• Older age
• APOE e4 status
• Hippocampal atrophy on structural MRI
• Vascular abnormalities
• Biomarker positivity: Tau and amyloid

Question 21

Reducing progression from MCI to Dementia

Answer 21

• Treating underlying conditions
• Stopping medications that may be causing cognitive decline
• Non pharmalogic interventions include:
• Regular physical exercise
• A diet in low fat and rich in fruits and vegetables
• Omega 3 fatty acids
• Keeping your brain active
• Being social

Question 22

Subjective Cognitive Decline (SCD)

Answer 22

• An indicator of declining cognitive function
• Pre clinical dementia
• Self perceived decline in memory and/or other cognitive abilities relative to the previous level of performance, but there is an absence of objective neuropsychological deficits
• Increases likelihood of having biomarker abnormalities consistent with dementia pathology
• Increases risk for future pathological cognitive decline and dementia

Question 23

Brain changes in SCD

Answer 23

• Atrophy: typically see people with SCD have less brain volume compared to non-SCD older adults increase complaints means more decline in the left and right hippocampi
• Amyloid buildup: Increases in amyloid deposits throughout the brain
• Tau buildup: Increases in tau, particularly in the enthorhinal region

Question 24

Conversion from SCD to MCI/Dementia

Answer 24

• Twice as likely to develop dementia than those with SCD
• Features that increase likelihood of preclinical AD
• Subject decline in memory rather than in other domains of cognition
• Age at onset of SCD is over 60
• Concerns associated with SCD
• Feeling of performing worse than others of the same age group
• Confirmation of cognitive decline by an informant
• Presence of the APOE e4 genotype
• Biomarker evidence for AD (defines preclinical AD)

Question 25

Sex differences in dementia

Answer 25

• There are more females diagnosed
• Females exhibit more pathology
• Females show more decline in cognition associated with the same amount of brain changes as males
• Females are more likely to have a faster progression than males

Question 26

Race differences in dementia

Answer 26

• Black older adults are twice as likely to develop dementia than white adults
• Racial differences exist in prevalence of risk factors
• Some studies suggest black older adults have a faster progression and shorter survival time after diagnosis than white older adults