NE8 MCI and Dementia

Normal advancing age can result in a number of neurophysiological changes. Select the change that is abnormal/not due to aging.

Subjective Cognitive Decline • This is a title given to individuals who [blank_start]report[blank_end] experiencing cognitive change-most typically [blank_start]memory[blank_end] deficits. • No impairment shown on cognitive [blank_start]testing[blank_end]. • There is increasing evidence that this subjectively experienced decline is associated with an [blank_start]increased[blank_end] risk of these patients experiencing [blank_start]future[blank_end] cognitive decline - and having biomarker abnormalities.

The DSM-V classifies MCI as “Mild Neurocognitive Disorder”. Their criteria are: A. Evidence of modest cognitive decline from a previous level of performance in [blank_start]one or more[blank_end] cognitive domains (e.g. complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based on: 1. Concern of the [blank_start]individual[blank_end], a knowledgeable informant, or the [blank_start]clinician[blank_end] that there has been a mild decline in functioning; and 2. A modest impairment in cognitive performance, [blank_start]preferably[blank_end] documented by standardised neuropsychological testing (usually 1-2 standard deviations below the expected range-between the 3rd and 16th percentiles). B. The cognitive deficits do not interfere with capacity for [blank_start]independence[blank_end] in everyday activities (but greater [blank_start]effort[blank_end], compensatory strategies, or accommodation may be required). C. The cognitive deficits do not occur exclusively in the context of a [blank_start]delirium[blank_end] D. The cognitive deficits are not better explained by another [blank_start]mental disorder[blank_end]

What’s the difference between MCI and Dementia? • In MCI there is a preservation of the person’s [blank_start]independence[blank_end] in functional abilities, and [blank_start]lack[blank_end] of significant impairment in [blank_start]occupational or social[blank_end] functioning. • A person with a dementia or Major Neurocognitive Disorder (DSM-IV) will display more significant deficits on their cognitive tests (>[blank_start]2 SD from the mean[blank_end]) and their functioning will have [blank_start]significantly[blank_end] declined.

Risk factors for developing MCI: • Age • Male • Lower [blank_start]educational[blank_end] level • Presence of [blank_start]apolipoprotein E[blank_end] allele • Family [blank_start]history[blank_end] of cognitive impairment • Presence of [blank_start]vascular[blank_end] risk factors (hypertension, hyperlipidaemia, coronary artery disease, and stroke) • [blank_start]Chronic[blank_end] health conditions e.g. hypertension, hyperlipidaemia, coronary artery disease, osteoarthritis, chronic obstructive pulmonary disease, depression, diabetes mellitus. • Those that are cognitively or physically [blank_start]sedentary[blank_end]

Not all cases of MCI are precursors to dementia and not all are [blank_start]progressive[blank_end]. Studies have found quite high [blank_start]reversal[blank_end] rates, with [blank_start]30% to 50%[blank_end] of patients originally diagnosed with MCI reverting back to “normal cognition” or remaining [blank_start]stable[blank_end] at follow-up assessments. SOME reversible Causes of MCI: • [blank_start]Poly[blank_end]pharmacy • Hypotension/Orthostatic [blank_start]Hyper[blank_end]tension • Depression • [blank_start]Hypo[blank_end]thyroidism • Vitamin [blank_start]B12[blank_end] Deficiency • Hypo/hyper[blank_start]glycemia[blank_end] • De[blank_start]hydration[blank_end]

Screening for MCI: MoCA (Montreal Cognitive Assessment) - Developed in 2005 as a brief [blank_start]screening[blank_end] instrument, not for diagnosis - Takes 10 [blank_start]minutes[blank_end] to administer and is scored out of [blank_start]30[blank_end] points. Initial norms recommended a cut off score of 26/25 (<[blank_start]25[blank_end] suspected of having MCI) but studies have shown that a cut off of 23/30 may be better as it allows fewer [blank_start]falsepositives[blank_end]. - Assesses multiple cognitive domains including attention, concentration, executive functioning, memory, language, visuospatial skills, abstraction, calculation and orientation. - The MoCA has excellent [blank_start]sensitivity[blank_end] in identifying MCI and AD (90% and 100% respectively). [blank_start]Specificity[blank_end] = 87% ([blank_start]true positive[blank_end] rate).

Choose the incorrect statement.

Treatments tend to focus on lifestyle modification: • Vascular [blank_start]risk[blank_end] factor control • Withdrawing and simplifying [blank_start]medication[blank_end] regimes may help • Physical [blank_start]exercise[blank_end] is highly protective • Engaging in meaningful mental [blank_start]stimulation[blank_end] and intellectual activity • Socialising • Maximising [blank_start]hearing[blank_end] • Ensure people with [blank_start]sleep[blank_end] disorders are assessed and treated • Management of depression and/or anxiety • Education around [blank_start]external memory aids[blank_end] e.g. diary, calendar, keeping keys/purse in the [blank_start]same[blank_end] spot, reminder notes • Trying to minimize risk: - driving assessments, [blank_start]occupational therapy assessment[blank_end] around safety in the home, etc • Family education