Chapter 11-7: Mild Cognitive Impairment (MCI)

TEXTBOOK PRESENTATION

Usually presents in an older patient complaining of memory loss. Common complaints are difficulty remembering names and appointments or solving complex problems. Detailed testing shows abnormal memory, but patients have no functional impairment.

DISEASE HIGHLIGHTS

1. MCI is a diagnosis that stands between the normal, age-related decline in cognition and dementia.

2. The diagnosis can be difficult to make as memory complaints, and concern about dementia, are very common in older people.

3. 4 types of MCI are:

   1. Single domain amnestic MCI in which people have memory loss and no other deficits.

   2. Multiple domain amnestic MCI in which people have memory loss as well as other deficits.

   3. Single domain non-amnestic MCI in which people have impairment in a single, non–memory-related, cognitive domain.

   4. Multiple domain non-amnestic MCI in which people have impairment in multiple, non–memory-related, cognitive domain.

4. Patients with this disorder are not neurologically normal.

   1. For patients with amnestic types of MCI, their memory is worse than age-matched controls.

   2. Patients with MCI have a higher rate of progression to dementia than age-matched controls.

EVIDENCE-BASED DIAGNOSIS

1. Patients with MCI generally have a normal score on MMSE (sensitivity only 18%).

2. The MoCA was initially developed to evaluate MCI; the test characteristics are:

   1. Sensitivity 90%

   2. Specificity 87%

   3. LR+ 6.92

   4. LR– 0.11

3. The diagnosis of MCI is often made on neuropsychiatric testing.

4. Evaluation for reversible causes, as in patients with dementia, is appropriate.

TREATMENT

Presently, there is no proven treatment for MCI. Patients should be monitored closely for development of more severe cognitive or functional decline.