NE8 MCI and Dementia

Subjective Cognitive Decline
• This is a title given to individuals who ❌ experiencing cognitive change-most typically ❌ deficits.
• No impairment shown on cognitive ❌.
• There is increasing evidence that this subjectively experienced decline is associated with an ❌ risk of these patients experiencing ❌ 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 ❌ cognitive domains (e.g. complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based
on:
1. Concern of the ❌, a knowledgeable informant, or the ❌ that there has been a mild decline in functioning; and
2. A modest impairment in cognitive performance, ❌ 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 ❌ in
everyday activities (but greater ❌, compensatory strategies, or accommodation may be required).
C. The cognitive deficits do not occur exclusively in the context of a ❌
D. The cognitive deficits are not better explained by another ❌

What’s the difference between MCI and Dementia?
• In MCI there is a preservation of the person’s ❌ in functional abilities, and ❌ of significant impairment in ❌ functioning.
• A person with a dementia or Major Neurocognitive Disorder (DSM-IV) will display more significant deficits on their cognitive tests (>❌) and their functioning will have ❌ declined.

Risk factors for developing MCI:
• Age
• Male
• Lower ❌ level
• Presence of ❌ allele
• Family ❌ of cognitive impairment
• Presence of ❌ risk factors (hypertension, hyperlipidaemia, coronary artery disease, and stroke)
• ❌ health conditions e.g. hypertension, hyperlipidaemia, coronary artery disease, osteoarthritis, chronic obstructive pulmonary disease, depression, diabetes mellitus.
• Those that are cognitively or physically ❌

Not all cases of MCI are precursors to dementia and not all are ❌. Studies have found quite high ❌ rates, with ❌ of patients originally diagnosed with MCI reverting back to “normal cognition” or remaining ❌ at follow-up assessments.
SOME reversible Causes of MCI:
• ❌pharmacy
• Hypotension/Orthostatic ❌tension
• Depression
• ❌thyroidism
• Vitamin ❌ Deficiency
• Hypo/hyper❌
• De❌

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

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