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Early Identification of Alzheimer's Disease: What Have we Learned from Mild Cognitive Impairment?

Published online by Cambridge University Press:  07 November 2014

Howard H. Feldman  and
Nagaendran Kandiah
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Extract

Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by cognitive decline, functional disability, and neuropsychiatric symptoms. Initial diagnosis is often delayed to a point when there is significant neurodegenerative pathology and secondary downstream pathogenic sequelae. The disease should be diagnosed during its earliest stage, as this would likely represent an ideal therapeutic window for disease-modifying therapies. Despite recent research that has focused on defining the clinically identifiable at-risk phase that precedes AD, reliable criteria for identifying patients in the prodromal to incipient stages of AD remain elusive.

In addressing the prodrome of AD, it has been clearly recognized that there are age-inappropriate cognitive declines that fall short of meeting the criteria for dementia. Most broadly, patients in this category have been classified as cognitively impaired not demented (CIND). In epidemiological studies, it has been estimated that 19% to 37% of patients ≥65 years of age are CIND. Conditions within the taxonomy of CIND include age-associated memory impairment (AAMI), age-associated cognitive decline (AACD), and mild cognitive impairment (MCI) (Slide 1).

AAMI is defined psychometrically by memory test scores that are ≥1 standard deviation below scores of young healthy control patients. AACD is characterized by scores in any cognitive domain that are ≥1 standard deviation below age- and education-adjusted normal measures. MCI is identified by memory function at a level ≥1.5 standard deviations below age- and education-adjusted means. Of these three conditions, MCI has been investigated most thoroughly and is defined by a clinical phenotype.

Type
Expert Review Supplement
Information
CNS Spectrums , Volume 13 , Issue S3: Next Steps in Alzheimer's Disease: Improvements in Diagnosis and Treatment , March 2008 , pp. 4 - 7
Copyright
Copyright © Cambridge University Press 2008

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References

1.Caselli, RJ, Beach, TG, Yaari, R, Reiman, EM. Alzheimer's disease a century later. J Clin Psychiatry. 2006;67(11):1784–1800.Google Scholar
2.Terry, AV Jr, Buccafusco, JJ. The cholinergic hypothesis of age and Alzheimer's disease-related cognitive deficits: recent challenges and their implications for novel drug development. J Pharmacol Exp Ther. 2003;306(3):821–827.Google Scholar
3.Vellas, B, Andrieu, S, Sampaio, C, Wilcock, G, for the European Task Force group. Disease-modifying trials in Alzheimer's disease: a European task force consensus. Lancet Neurol. 2007;6(1):56–62.CrossRefGoogle ScholarPubMed
4.Hamaguchi, T, Ono, K, Yamada, M. Anti-amyloidogenic therapies: strategies for prevention and treatment of Alzheimer's disease. Cell Mol Life Sci. 2006;63(13):1538–1552.Google Scholar
5.Graham, JE, Rockwood, K, Beattie, BL, et al.Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet. 1997;349(90B8):1793–1796.Google Scholar
6.Unverzagt, FW, Gao, S, Baiyewu, O, et al.Prevalence of cognitive impairment: data from the Indianapolis Study of Health and Aging. Neurology. 2001;57(9):1655–1662.Google Scholar
7.Crook, T, Bartus, R, Ferris, SH, et al.Age-associated memory impairment: proposed diagnostic criteria and measures of clinical change: report of a National Institute of Mental Health Work Group. Dev Neuropsychol. 1986;2:261–276.CrossRefGoogle Scholar
8.Hanninen, T, Koivisto, K, Reinikainen, KJ, et al.Aging-associated cognitive decline. Age Ageing. 1996;25:201–205.Google Scholar
9.Petersen, RC, Smith, GE, Waring, SC, Ivnik, RJ, Tangalos, EG, Kokmen, E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–308.CrossRefGoogle ScholarPubMed
10.Erkinjuntti, T, Laaksonen, R, Sulkava, R, Syrjäläinen, R, Palo, J. Neuropsychological differentiation between normal aging, Alzheimer's disease and vascular dementia. Acta Neurol Scand. 1986;74(5):393–403.Google Scholar
11.Anthony, JC, LeResche, L, Niaz, U, von Korff, MR, Folstein, MF. Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients. Psychol Med. 1982;12(2):397–408.Google Scholar
12.Kokmen, E, Naessens, JM, Offord, KP. A short test of mental status: description and preliminary results. Mayo Clin Proc. 1987;62(4):281–288.Google Scholar
13.Nasreddine, ZS, Phillips, NA, Bedirian, V, et al.The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.CrossRefGoogle Scholar
14.Petersen, RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256(3):183–194.CrossRefGoogle ScholarPubMed
15.Stephan, BC, Matthews, FE, McKeith, IG, et al.Early cognitive change in the general population: how do different definitions work? J Am Geriatr Soc. 2007;55(10):1534–1540.CrossRefGoogle ScholarPubMed
16.Winblad, B, Gauthier, S, Scinto, L, et al.Safety of galantamine in subjects with mild cognitive impairment. Neurology. 2008. In press.Google Scholar
17.Feldman, HH, Ferris, S, Winblad, B, et al.Effect of rivastigmine on delay to diagnosis of Alzheimer's disease from mild cognitive impairment: the InDDEx study. Lancet Neurol. 2007;6(6):501–512.Google Scholar
18.Petersen, RC, Thomas, RG, Grundman, M, et al.Vitamin E and donepezil for the treatment of mild cognitive impairment. N EnglJ Med. 2005;352(23):2379–2388.Google Scholar
19.Thal, LJ, Ferris, SH, Kirby, L, et al.A randomized, double blind study of rofecoxib in patients with mild cognitive impairment. Neuropsychopharmacology 2005;30(6):1204–1215.Google Scholar
20.Feldman, H, Scheltens, P, Scarpini, E, Mancione, L, Lane, R. Operational criteria for confirmation of clinical diagnosis of Alzheimer's disease in patients with mild cognitive impairment. Neurobiol Aging. 2004;25(suppl 2):S472.Google Scholar
21.Visser, PJ, Scheltens, P, Verhey, FR. Do MCI criteria in drug trials accurately identify subjects with predementia Alzheimer's disease? J Neurol Neurosurg Psychiatry. 2005;76(10):1348–1354.Google Scholar
22.Tierney, MC, Szalai, JP, Snow, WG, et al.A prospective study of the clinical utility of ApoE genotype in the prediction of outcome in patients with memory impairment. Neurology. 1996;46(1):149–154.Google Scholar
23.Corder, EH, Huang, R, Cathcart, HM, et al.Membership in genetic groups predicts Alzheimer disease. Rejuvenation Res. 2006;9(1):89–93.CrossRefGoogle ScholarPubMed
24.Potter, GG, Plassman, BL, Helms, MJ, Steffens, DC, Welsh-Bohmer, KA. Age effects of coronary artery bypass graft on cognitive status change among elderly male twins. Neurology. 2004;63(12):2245–2249.Google Scholar
25.Polidori, MC, Marvardi, M, Cherubini, A, Senin, U, Mecocci, P. Heart disease and vascular risk factors in the cognitively impaired elderly: implications for Alzheimer's dementia. Aging (Milano). 2001;13(3):231–239.Google Scholar
26.Morris, JC. Mild cognitive impairment is early-stage Alzheimer disease: time to revise diagnostic criteria. Arch Neurol. 2006;63(1):15–16.CrossRefGoogle ScholarPubMed
27.Dubois, B, Feldman, HH, Jacova, C, et al.Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. 2007;6(8):734–746.Google Scholar