Mild Cognitive Impairment: Evolution of the Clinical Diagnosis

Mild Cognitive Impairment: Evolution of the Clinical Diagnosis

Pallavi Sinha (North Delhi Municipal Corporation Medical College, India & Hindu Rao Hospital, India) and Amit Garg (Felicity Mindcare Clinic, India)
Copyright: © 2018 |Pages: 18
DOI: 10.4018/978-1-5225-3480-8.ch008

Abstract

This chapter describes how the world population is ageing with the advances in medical health technology. Longevity allows many humans to live beyond the sixth and seventh decade. With this comes the added medical co-morbidity that one sees with healthy ageing. Mild cognitive impairment (MCI) includes a heterogeneous group of persons who have declining deficits in cognitions with minimal impairment in doing complex activities with no deficits in daily activities and in the absence of dementia. The purpose of this chapter is to acquaint the readers with the concept of Mild Cognitive Impairment and the evolution of the diagnosis to its current nosological status. It will further elaborate on the assessment and management of patients with MCI.
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Evolution Of Criteria For Mild Cognitive Impairment

It would be simplistic to assume MCI as a transitional state between normal ageing and dementia. However there appears some overlap between both MCI with normal ageing and MCI with dementia. The original 1999 Mayo criteria assumed MCI to be a precursor state for Alzheimer’s Dementia and emphasized on episodic memory impairment. These were (Petersen et al., 1999):

  • 1.

    Memory complaint, preferably corroborated by informant

  • 2.

    Memory impairment documented according to appropriate reference values

  • 3.

    Essentially normal performance in non-memory cognitive domains

  • 4.

    Generally reserved activities of daily living

  • 5.

    Absence of dementia

However, since not all MCI progressed to Alzheimer’s dementia, a broader conceptualization of the diagnostic criteria were required. A neuropsychological assessment of a subset of patients with MCI revealed subtle deficits in other cognitive domains like executive functioning, language and visuo-spatial skills (Molano et al., 2010). These patients were at higher risk of converting to Lewy body dementia or fronto-temporal dementia. With the expanding literature on MCI suggesting that it is a heterogenous group and not just a precursor of Alzheimer’s dementia, the revised Mayo criteria were published in 2003 (Petersen, 2004) which expanded to include cognitive deficits in domains other than memory. They divided MCI into amnestic MCI (aMCI) and Non-amnestic MCI (naMCI) based on the type of cognitive deficits present.

Key Terms in this Chapter

Cognitions: Mental process of acquiring information and understanding it through thought, experience and perception.

Executive Functions: Mental process required for planning, organizing and completing tasks.

Activity of Daily Living: Basic self-care tasks like bathing, eating.

Amnesia: Loss of memory.

Dementia: Impairment in memory and/ or other cognitive domains with difficulty in carrying out activities of daily living.

Mild Cognitive Impairment: Presence of clinically observed and significant impairment in cognitive functions without any deficits in day to day functioning.

Memory: Memory as a mental process of storing, encoding and retrieving information.

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