Skip to main content

Advertisement

SpringerLink
Log in

Mild Cognitive Impairment in Older Adults

  • Geriatric Disorders (Dc Steffens, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Mild cognitive impairment (MCI) is the intermediate stage between the cognitive changes of normal aging and dementia. MCI is important because it constitutes a high risk group for dementia. Ideally, prevention strategies should target individuals who are not even symptomatic. Indeed, the field is now moving towards identification of asymptomatic individuals who have underlying Alzheimer’s disease (AD) pathology that can be detected using biomarkers and neuroimaging technologies. To this effect, the Alzheimer’s Association and the National Institute on Aging have developed a new classification scheme that has categorized AD into a preclinical phase (research category), MCI due to AD, and dementia of Alzheimer’s type. However, there are also ongoing research studies to understand high-risk groups for non-Alzheimer’s dementia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •  Of importance •• Of major importance

  1. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56:303–8.

    Article  PubMed  CAS  Google Scholar 

  2. Reisberg B, Ferris SH, de Leon MJ, Crook T. Global Deterioration Scale (GDS). Psychopharmacol Bull. 1988;24:661–3.

    PubMed  CAS  Google Scholar 

  3. Reisberg B, Ferris SH, de Leon MJ, et al. Stage-specific behavioral, cognitive, and in vivo changes in community residing subjects with age-associated memory impairment and primary degenerative dementia of the Alzheimer's type. Drug Development Research. 1988;15:101–114.

    Google Scholar 

  4. Flicker C, Ferris SH, Reisberg B. Mild cognitive impairment in the elderly: predictors of dementia. Neurology. 1991;41:1006–9.

    Article  PubMed  CAS  Google Scholar 

  5. Kral VA. Senescent forgetfulness: benign and malignant. Can Med Assoc J. 1962;86:257–60.

    PubMed  CAS  Google Scholar 

  6. Crook T, Bartus RT, Ferris SH, Whitehouse P, Cohen GD, Gershon S. Age-associated memory impairment: proposed diagnostic criteria and measures of clinical change—report of a National Institute of Mental Health work group. Development Neuropsychol. 1986;2:261–76.

    Article  Google Scholar 

  7. Levy R. Aging-associated cognitive decline. Working party of the International Psychogeriatric Association in collaboration with the World Health Organization. Int Psychogeriatr. 1994;6:63–8.

    Article  PubMed  CAS  Google Scholar 

  8. American Psychiatric Association, American Psychiatric Association. Task Force on DSM-IV. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  9. Blackford RC, La Rue A. Criteria for diagnosing age-associated memory impairment: proposed improvements from the field. Development Neuropsychol. 1989;5:295–306.

    Article  Google Scholar 

  10. Devanand DP, Folz M, Gorlyn M, Moeller JR, Stern Y. Questionable dementia: clinical course and predictors of outcome. J Am Geriatr Soc. 1997;45:321–8.

    PubMed  CAS  Google Scholar 

  11. Reisberg B, Prichep L, Mosconi L, John ER, Glodzik-Sobanska L, Boksay I, et al. The pre-mild cognitive impairment, subjective cognitive impairment stage of Alzheimer's disease. Alzheimers Dement. 2008;4 Suppl 1:S98–108.

    Article  PubMed  Google Scholar 

  12. Grundman M, Petersen RC, Ferris SH, Thomas RG, Aisen PS, Bennett DA, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol. 2004;61:59–66.

    Article  PubMed  Google Scholar 

  13. •• Petersen RC. Clinical practice. Mild cognitive impairment. N Engl J Med. 2011;364:2227–34. This reference is the most up-to-date review, particularly on advances made in the area of biomarkers and neuroimaging research pertinent to MCI and AD.

    Article  PubMed  CAS  Google Scholar 

  14. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment–beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256:240–6.

    Article  PubMed  CAS  Google Scholar 

  15. Williams JW, United States. Agency for Healthcare Research and Quality. Duke University Evidence-based Practice Center. Preventing Alzheimer's disease and cognitive decline. Evidence report/technology assessment,, vol no 193. Agency for Healthcare Research and Quality, Rockville, MD; 2010.

  16. Brookmeyer R, Gray S, Kawas C. Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. Am J Public Health. 1998;88:1337–42.

    Article  PubMed  CAS  Google Scholar 

  17. Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer's disease. Alzheimers Dement. 2007;3:186–91.

    Article  PubMed  Google Scholar 

  18. Rice DP, Fox PJ, Max W, Webber PA, Lindeman DA, Hauck WW, et al. The economic burden of Alzheimer's disease care. Health Aff (Millwood). 1993;12:164–76.

    Article  CAS  Google Scholar 

  19. Geda YE, Negash S, Petersen RC. Memory disorders. In: Agronin ME, Maletta GJ (eds). Principles and practice of geriatric psychiatry. Lippincott Williams & Wilkins, Philadelphia, PA; 2006.

  20. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al. Current concepts in mild cognitive impairment. Arch Neurol. 2001;58:1985–92.

    Article  PubMed  CAS  Google Scholar 

  21. • Sperling RA, Aisen PS, Beckett LA, Bennett DA, Craft S, Fagan AM, et al. Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:280–92. This article describes AA-NIA research criteria for asymptomatic AD. Very useful in a research setting.

    Article  PubMed  Google Scholar 

  22. • Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:270–9. This article describes the criteria for MCI due to AD.

    Article  PubMed  Google Scholar 

  23. • McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack Jr CR, Kawas CH, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:263–9. This article describes the AA-NIA criteria for the diagnosis of dementia due to AD. Involvement of memory domain does not have a central place in the diagnostic criteria for dementia of Alzheimer's type. This is in sharp contrast with the DSM-IV criteria for dementia of Alzheimer's type.

    Article  PubMed  Google Scholar 

  24. •• Ganguli M, Blacker D, Blazer DG, Grant I, Jeste DV, Paulsen JS, et al. Classification of neurocognitive disorders in DSM-5: a work in progress. Am J Geriatr Psychiatry. 2011;19:205–10. This is a very important reference in order to understand the ongoing work of the DSM-5 task force on neurocognitive disorders, including MCI.

    Article  PubMed  Google Scholar 

  25. Molano J, Boeve B, Ferman T, Smith G, Parisi J, Dickson D, et al. Mild cognitive impairment associated with limbic and neocortical Lewy body disease: a clinicopathological study. Brain. 2010;133:540–56.

    Article  PubMed  Google Scholar 

  26. Ganguli M, Dodge HH, Shen C, DeKosky ST. Mild cognitive impairment, amnestic type: an epidemiologic study. Neurology. 2004;63:115–21.

    Article  PubMed  Google Scholar 

  27. Hanninen T, Hallikainen M, Tuomainen S, Vanhanen M, Soininen H. Prevalence of mild cognitive impairment: a population-based study in elderly subjects. Acta Neurol Scand. 2002;106:148–54.

    Article  PubMed  CAS  Google Scholar 

  28. Larrieu S, Letenneur L, Orgogozo JM, Fabrigoule C, Amieva H, Le Carret N, et al. Incidence and outcome of mild cognitive impairment in a population-based prospective cohort. Neurology. 2002;59:1594–9.

    Article  PubMed  CAS  Google Scholar 

  29. •• Roberts RO, Geda YE, Knopman DS, Cha RH, Pankratz VS, Boeve BF, et al. The incidence of MCI differs by subtype and is higher in men: the Mayo Clinic study of aging. Neurology. 2012;78:342–51. This reference contains the most recent population-based estimates of the incidence of MCI. Thearticle has reported unexpected differences in incidence of MCI by sex, i.e., the incidence of MCI is higher in men than in women.

    Article  PubMed  CAS  Google Scholar 

  30. Sackett DL. Bias in analytic research. J Chronic Dis. 1979;32:51–63.

    Article  PubMed  CAS  Google Scholar 

  31. Petersen RC, Roberts RO, Knopman DS, Geda YE, Cha RH, Pankratz VS, et al. Prevalence of mild cognitive impairment is higher in men. The Mayo Clinic study of aging. Neurology. 2010;75:889–97.

    Article  PubMed  CAS  Google Scholar 

  32. Roberts RO, Geda YE, Knopman DS, Cha RH, Pankratz VS, Boeve BF, et al. The Mayo Clinic study of aging: design and sampling, participation, baseline measures and sample characteristics. Neuroepidemiology. 2008;30:58–69.

    Article  PubMed  Google Scholar 

  33. Lopez OL, Jagust WJ, DeKosky ST, Becker JT, Fitzpatrick A, Dulberg C, et al. Prevalence and classification of mild cognitive impairment in the Cardiovascular health study cognition study: part 1. Arch Neurol. 2003;60:1385–9.

    Article  PubMed  Google Scholar 

  34. Kumar R, Dear KB, Christensen H, Ilschner S, Jorm AF, Meslin C, et al. Prevalence of mild cognitive impairment in 60- to 64-year-old community-dwelling individuals: the personality and total health through Life 60+ Study. Dement Geriatr Cogn Disord. 2005;19:67–74.

    Article  PubMed  Google Scholar 

  35. Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005;352:2379–88.

    Article  PubMed  CAS  Google Scholar 

  36. Tierney MC, Szalai JP, Snow WG, Fisher RH, Tsuda T, Chi H, et al. A prospective study of the clinical utility of ApoE genotype in the prediction of outcome in patients with memory impairment. Neurology. 1996;46:149–54.

    Article  PubMed  CAS  Google Scholar 

  37. Daly E, Zaitchik D, Copeland M, Schmahmann J, Gunther J, Albert M. Predicting conversion to Alzheimer disease using standardized clinical information. Arch Neurol. 2000;57:675–80.

    Article  PubMed  CAS  Google Scholar 

  38. Ritchie K, Artero S, Touchon J. Classification criteria for mild cognitive impairment: a population-based validation study. Neurology. 2001;56:37–42.

    Article  PubMed  CAS  Google Scholar 

  39. Benton A, Hamsher K. Multilingual aphasia examination manual. Iowa City: University of Iowa; 1978.

    Google Scholar 

  40. Mesulam MM. From sensation to cognition. Brain. 1998;121:1013–52.

    Article  PubMed  Google Scholar 

  41. Kokmen E, Naessens JM, Offord KP. A short test of mental status: description and preliminary results. Mayo Clin Proc. 1987;62:281–8.

    PubMed  CAS  Google Scholar 

  42. Tang-Wai DF, Knopman DS, Geda YE, Edland SD, Smith GE, Ivnik RJ, et al. Comparison of the short test of mental status and the mini-mental state examination in mild cognitive impairment. Arch Neurol. 2003;60:1777–81.

    Article  PubMed  Google Scholar 

  43. Ferrarini L, Frisoni GB, Pievani M, Reiber JH, Ganzola R, Milles J. Morphological hippocampal markers for automated detection of Alzheimer's disease and mild cognitive impairment converters in magnetic resonance images. J Alzheimers Dis. 2009;17:643–59.

    PubMed  Google Scholar 

  44. Klunk WE, Engler H, Nordberg A, Wang Y, Blomqvist G, Holt DP, et al. Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B. Ann Neurol. 2004;55:306–19.

    Article  PubMed  CAS  Google Scholar 

  45. Mintun MA, Larossa GN, Sheline YI, Dence CS, Lee SY, Mach RH, et al. [11C]PIB in a nondemented population: potential antecedent marker of Alzheimer disease. Neurology. 2006;67:446–52.

    Article  PubMed  CAS  Google Scholar 

  46. Engler H, Forsberg A, Almkvist O, Blomquist G, Larsson E, Savitcheva I, et al. Two-year follow-up of amyloid deposition in patients with Alzheimer's disease. Brain. 2006;129:2856–66.

    Article  PubMed  Google Scholar 

  47. Klunk WE, Mathis CA, Price JC, Lopresti BJ, DeKosky ST. Two-year follow-up of amyloid deposition in patients with Alzheimer's disease. Brain. 2006;129:2805–7.

    Article  PubMed  Google Scholar 

  48. Morris JC, Roe CM, Grant EA, Head D, Storandt M, Goate AM, et al. Pittsburgh compound B imaging and prediction of progression from cognitive normality to symptomatic Alzheimer disease. Arch Neurol. 2009;66:1469–75.

    Article  PubMed  Google Scholar 

  49. Petersen RC. Mild cognitive impairment clinical trials. Nat Rev Drug Discov. 2003;2:646–53.

    Article  PubMed  CAS  Google Scholar 

  50. Knapp MJ, Knopman DS, Solomon PR, Pendlebury WW, Davis CS, Gracon SI. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer's disease. The Tacrine study group. JAMA. 1994;271:985–91.

    Article  PubMed  CAS  Google Scholar 

  51. Rogers SL, Farlow MR, Doody RS, Mohs R, Friedhoff LT. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Donepezil study group. Neurology. 1998;50:136–45.

    Article  PubMed  CAS  Google Scholar 

  52. Rosler M, Anand R, Cicin-Sain A, Gauthier S, Agid Y, Dal-Bianco P, et al. Efficacy and safety of rivastigmine in patients with Alzheimer's disease: international randomised controlled trial. BMJ. 1999;318:633–8.

    Article  PubMed  CAS  Google Scholar 

  53. Wilcock GK, Lilienfeld S, Gaens E. Efficacy and safety of galantamine in patients with mild to moderate Alzheimer's disease: multicentre randomised controlled trial. Galantamine International-1 study group. BMJ. 2000;321:1445–9.

    Article  PubMed  CAS  Google Scholar 

  54. Cummings JL, Schneider L, Tariot PN, Kershaw PR, Yuan W. Reduction of behavioral disturbances and caregiver distress by galantamine in patients with Alzheimer's disease. Am J Psychiatry. 2004;161:532–8.

    Article  PubMed  Google Scholar 

  55. Reisberg B, Doody R, Stoffler A, Schmitt F, Ferris S, Mobius HJ. Memantine in moderate-to-severe Alzheimer's disease. N Engl J Med. 2003;348:1333–41.

    Article  PubMed  CAS  Google Scholar 

  56. Tariot PN, Farlow MR, Grossberg GT, Graham SM, McDonald S, Gergel I. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA. 2004;291:317–24.

    Article  PubMed  CAS  Google Scholar 

  57. Lockhart BP, Lestage PJ. Cognition enhancing or neuroprotective compounds for the treatment of cognitive disorders: why? when? which? Exp Gerontol. 2003;38:119–28.

    Article  PubMed  CAS  Google Scholar 

  58. Hayes TL, Larimer N, Adami A, Kaye JA. Medication adherence in healthy elders: small cognitive changes make a big difference. J Aging Health. 2009;21:567–80.

    Article  PubMed  Google Scholar 

  59. Lloret A, Badia MC, Mora NJ, Pallardo FV, Alonso MD, Vina J. Vitamin E paradox in Alzheimer's disease: it does not prevent loss of cognition and may even be detrimental. J Alzheimers Dis. 2009;17:143–9.

    PubMed  CAS  Google Scholar 

  60. Miller 3rd ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142:37–46.

    PubMed  CAS  Google Scholar 

  61. Geda YE, Petersen RC. Clinical trials in mild cognitive impairment. In: Gauthier S, Cummings J (eds). Alzheimer's disease and related disorders. 2nd edn. Martin Dunitz, London; 2001.

  62. Salloway S, Ferris S, Kluger A, Goldman R, Griesing T, Kumar D, et al. Efficacy of donepezil in mild cognitive impairment: a randomized placebo-controlled trial. Neurology. 2004;63:651–7.

    Article  PubMed  CAS  Google Scholar 

  63. Diniz BS, Pinto Jr JA, Gonzaga ML, Guimaraes FM, Gattaz WF, Forlenza OV. To treat or not to treat? A meta-analysis of the use of cholinesterase inhibitors in mild cognitive impairment for delaying progression to Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci. 2009;259:248–56.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

I would like to thank Ronald C. Petersen, MD, PhD, and all other members of Mayo Clinic Study of Aging and Mayo Alzheimer's Center for their consistent and undying support. Additionally, I would like to thank Barbara J. Balgaard for her superb secretarial assistance. Preparation of this article was supported by K01 MH68351, U01 AG06786, P50 AG16574, and RR024150 from the National Institutes of Health and the Robert Wood Johnson Foundation.

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychology, and Department of Neurology. Collaborative Research Building, Mayo Clinic, Scottsdale, AZ, USA

    Yonas E. Geda

Authors
  1. Yonas E. Geda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yonas E. Geda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Geda, Y.E. Mild Cognitive Impairment in Older Adults. Curr Psychiatry Rep 14, 320–327 (2012). https://doi.org/10.1007/s11920-012-0291-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-012-0291-x

Keywords

Search

Navigation