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American Journal of Alzheimer's Disease... Dec 2018The spectrum of cognitive decline in the elderly ranges from what can be classified as normal cognitive decline with aging to subjective cognitive impairment to mild... (Review)
Review
The spectrum of cognitive decline in the elderly ranges from what can be classified as normal cognitive decline with aging to subjective cognitive impairment to mild cognitive impairment (MCI) to dementia. This article reviewed the up-to-date evidence of MCI including the diagnostic criteria of MCI due to Alzheimer's disease, vascular cognitive impairment and MCI due to Parkinson disease, management and preventive intervention of MCI. There are various etiologies of MCI, and a large number of studies have been conducted to ascertain the practical modalities of preserving cognition in predementia stages. Lifestyle modification, such as aerobic exercise, is an approved modality to preserve cognitive ability and decrease the rate of progression to dementia, as well as being recommended for frailty prevention.
Topics: Alzheimer Disease; Cognitive Dysfunction; Disease Progression; Exercise; Humans; Life Style; Neuropsychological Tests; Risk Factors
PubMed: 30068225
DOI: 10.1177/1533317518791401 -
The Lancet. Neurology Oct 2020Multiple sclerosis is a chronic, demyelinating disease of the CNS. Cognitive impairment is a sometimes neglected, yet common, sign and symptom with a profound effect on... (Review)
Review
Multiple sclerosis is a chronic, demyelinating disease of the CNS. Cognitive impairment is a sometimes neglected, yet common, sign and symptom with a profound effect on instrumental activities of daily living. The prevalence of cognitive impairment in multiple sclerosis varies across the lifespan and might be difficult to distinguish from other causes in older age. MRI studies show that widespread changes to brain networks contribute to cognitive dysfunction, and grey matter atrophy is an early sign of potential future cognitive decline. Neuropsychological research suggests that cognitive processing speed and episodic memory are the most frequently affected cognitive domains. Narrowing evaluation to these core areas permits brief, routine assessment in the clinical setting. Owing to its brevity, reliability, and sensitivity, the Symbol Digit Modalities Test, or its computer-based analogues, can be used to monitor episodes of acute disease activity. The Symbol Digit Modalities Test can also be used in clinical trials, and data increasingly show that cognitive processing speed and memory are amenable to cognitive training interventions.
Topics: Adolescent; Aged, 80 and over; Cognitive Dysfunction; Disease Management; Female; Humans; Magnetic Resonance Imaging; Multiple Sclerosis
PubMed: 32949546
DOI: 10.1016/S1474-4422(20)30277-5 -
The International Journal of... Aug 2017Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it... (Review)
Review
Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients' psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients.
Topics: Bipolar Disorder; Cognitive Dysfunction; Humans
PubMed: 28498954
DOI: 10.1093/ijnp/pyx032 -
JAMA Dec 2014Cognitive decline is a common and feared aspect of aging. Mild cognitive impairment (MCI) is defined as the symptomatic predementia stage on the continuum of cognitive... (Review)
Review
IMPORTANCE
Cognitive decline is a common and feared aspect of aging. Mild cognitive impairment (MCI) is defined as the symptomatic predementia stage on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living.
OBJECTIVE
To present evidence on the diagnosis, treatment, and prognosis of MCI and to provide physicians with an evidence-based framework for caring for older patients with MCI and their caregivers.
EVIDENCE ACQUISITION
We searched PubMed for English-language articles in peer-reviewed journals and the Cochrane Library database from inception through July 2014. Relevant references from retrieved articles were also evaluated.
FINDINGS
The prevalence of MCI in adults aged 65 years and older is 10% to 20%; risk increases with age and men appear to be at higher risk than women. In older patients with MCI, clinicians should consider depression, polypharmacy, and uncontrolled cardiovascular risk factors, all of which may increase risk for cognitive impairment and other negative outcomes. Currently, no medications have proven effective for MCI; treatments and interventions should be aimed at reducing cardiovascular risk factors and prevention of stroke. Aerobic exercise, mental activity, and social engagement may help decrease risk of further cognitive decline. Although patients with MCI are at greater risk for developing dementia compared with the general population, there is currently substantial variation in risk estimates (from <5% to 20% annual conversion rates), depending on the population studied. Current research targets improving early detection and treatment of MCI, particularly in patients at high risk for progression to dementia.
CONCLUSIONS AND RELEVANCE
Cognitive decline and MCI have important implications for patients and their families and will require that primary care clinicians be skilled in identifying and managing this common disorder as the number of older adults increases in coming decades. Current evidence supports aerobic exercise, mental activity, and cardiovascular risk factor control in patients with MCI.
Topics: Aged; Aging; Cardiovascular Diseases; Cognitive Dysfunction; Dementia; Disease Progression; Exercise; Female; Humans; Male; Prognosis; Risk Factors
PubMed: 25514304
DOI: 10.1001/jama.2014.13806 -
Continuum (Minneapolis, Minn.) Apr 2016As individuals age, the quality of cognitive function becomes an increasingly important topic. The concept of mild cognitive impairment (MCI) has evolved over the past 2... (Review)
Review
PURPOSE OF REVIEW
As individuals age, the quality of cognitive function becomes an increasingly important topic. The concept of mild cognitive impairment (MCI) has evolved over the past 2 decades to represent a state of cognitive function between that seen in normal aging and dementia. As such, it is important for health care providers to be aware of the condition and place it in the appropriate clinical context.
RECENT FINDINGS
Numerous international population-based studies have been conducted to document the frequency of MCI, estimating its prevalence to be between 15% and 20% in persons 60 years and older, making it a common condition encountered by clinicians. The annual rate in which MCI progresses to dementia varies between 8% and 15% per year, implying that it is an important condition to identify and treat. In those MCI cases destined to develop Alzheimer disease, biomarkers are emerging to help identify etiology and predict progression. However, not all MCI is due to Alzheimer disease, and identifying subtypes is important for possible treatment and counseling. If treatable causes are identified, the person with MCI might improve.
SUMMARY
MCI is an important clinical entity to identify, and while uncertainties persist, clinicians need to be aware of its diagnostic features to enable them to counsel patients. MCI remains an active area of research as numerous randomized controlled trials are being conducted to develop effective treatments.
Topics: Cognitive Dysfunction; Disease Progression; Humans
PubMed: 27042901
DOI: 10.1212/CON.0000000000000313 -
Neurology Jan 2018To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI).
Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.
OBJECTIVE
To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI).
METHODS
The guideline panel systematically reviewed MCI prevalence, prognosis, and treatment articles according to AAN evidence classification criteria, and based recommendations on evidence and modified Delphi consensus.
RESULTS
MCI prevalence was 6.7% for ages 60-64, 8.4% for 65-69, 10.1% for 70-74, 14.8% for 75-79, and 25.2% for 80-84. Cumulative dementia incidence was 14.9% in individuals with MCI older than age 65 years followed for 2 years. No high-quality evidence exists to support pharmacologic treatments for MCI. In patients with MCI, exercise training (6 months) is likely to improve cognitive measures and cognitive training may improve cognitive measures.
MAJOR RECOMMENDATIONS
Clinicians should assess for MCI with validated tools in appropriate scenarios (Level B). Clinicians should evaluate patients with MCI for modifiable risk factors, assess for functional impairment, and assess for and treat behavioral/neuropsychiatric symptoms (Level B). Clinicians should monitor cognitive status of patients with MCI over time (Level B). Cognitively impairing medications should be discontinued where possible and behavioral symptoms treated (Level B). Clinicians may choose not to offer cholinesterase inhibitors (Level B); if offering, they must first discuss lack of evidence (Level A). Clinicians should recommend regular exercise (Level B). Clinicians may recommend cognitive training (Level C). Clinicians should discuss diagnosis, prognosis, long-term planning, and the lack of effective medicine options (Level B), and may discuss biomarker research with patients with MCI and families (Level C).
Topics: Cognitive Dysfunction; Delphi Technique; Humans
PubMed: 29282327
DOI: 10.1212/WNL.0000000000004826 -
Current Diabetes Reports Sep 2016Both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) have been associated with reduced performance on multiple domains of cognitive function and with evidence of... (Review)
Review
Both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) have been associated with reduced performance on multiple domains of cognitive function and with evidence of abnormal structural and functional brain magnetic resonance imaging (MRI). Cognitive deficits may occur at the very earliest stages of diabetes and are further exacerbated by the metabolic syndrome. The duration of diabetes and glycemic control may have an impact on the type and severity of cognitive impairment, but as yet we cannot predict who is at greatest risk of developing cognitive impairment. The pathophysiology of cognitive impairment is multifactorial, although dysfunction in each interconnecting pathway ultimately leads to discordance in metabolic signaling. The pathophysiology includes defects in insulin signaling, autonomic function, neuroinflammatory pathways, mitochondrial (Mt) metabolism, the sirtuin-peroxisome proliferator-activated receptor-gamma co-activator 1α (SIRT-PGC-1α) axis, and Tau signaling. Several promising therapies have been identified in pre-clinical studies, but remain to be validated in clinical trials.
Topics: Animals; Brain; Cognitive Dysfunction; Diabetes Mellitus, Type 2; Humans; Magnetic Resonance Imaging; Mitochondria; Signal Transduction
PubMed: 27491830
DOI: 10.1007/s11892-016-0775-x -
Stroke Jun 2023Cognitive impairment is a common consequence of stroke and has direct implications for poststroke functioning and quality of life, including the ability to maintain a... (Review)
Review
PURPOSE
Cognitive impairment is a common consequence of stroke and has direct implications for poststroke functioning and quality of life, including the ability to maintain a job, live independently, sustain interpersonal relationships, and drive a vehicle. In this scientific statement, we critically appraise the literature on the prevalence, diagnosis, and management of poststroke cognitive impairment (PSCI) and provide a framework for clinical care while highlighting gaps that merit further study.
METHODS
We performed a scoping literature review of randomized controlled clinical trials, prospective and retrospective cohort studies, case-control studies, clinical guidelines, review articles, and editorials on the incidence and prevalence, natural history, diagnosis, and management of PSCI. Scoping reviews determine the scope of a body of literature on a given topic to indicate the volume of literature and the studies currently available and provide an overview of its focus.
RESULTS
PSCI is common after stroke, especially in the first year, and ranges from mild to severe. Although cognitive impairment is reversible in some cases early after stroke, up to one-third of individuals with stroke develop dementia within 5 years. The pathophysiology is not yet fully elucidated but is likely attributable to an acute stroke precipitating a series of pathological events, often in the setting of preexisting microvascular and neurodegenerative changes. Screening for associated comorbidities and interdisciplinary management are integral components of the care of individuals with PSCI. There is a need for prospective studies evaluating the individual trajectory of PSCI and the role of the acute vascular event in the predisposition for Alzheimer disease and related dementias, as well as high-quality, randomized clinical trials focused on PSCI management.
Topics: Humans; Hemorrhagic Stroke; Prospective Studies; American Heart Association; Quality of Life; Retrospective Studies; Stroke; Cognitive Dysfunction
PubMed: 37125534
DOI: 10.1161/STR.0000000000000430 -
Annual Review of Pharmacology and... Jan 2023Cognitive impairment is a core feature of schizophrenia and a major contributor to poor functional outcomes. Methods for assessment of cognitive dysfunction in... (Review)
Review
Cognitive impairment is a core feature of schizophrenia and a major contributor to poor functional outcomes. Methods for assessment of cognitive dysfunction in schizophrenia are now well established. In addition, there has been increasing appreciation in recent years of the additional role of social cognitive impairment in driving functional outcomes and of the contributions of sensory-level dysfunction to higher-order impairments. At the neurochemical level, acute administration of -methyl-d-aspartate receptor (NMDAR) antagonists reproduces the pattern of neurocognitive dysfunction associated with schizophrenia, encouraging the development of treatments targeted at both NMDAR and its interactome. At the local-circuit level, an auditory neurophysiological measure, mismatch negativity, has emerged both as a veridical index of NMDAR dysfunction and excitatory/inhibitory imbalance in schizophrenia and as a critical biomarker for early-stage translational drug development. Although no compounds have yet been approved for treatment of cognitive impairment associated with schizophrenia, several candidates are showing promise in early-phase testing.
Topics: Humans; Schizophrenia; Cognitive Dysfunction
PubMed: 36151052
DOI: 10.1146/annurev-pharmtox-051921-093250 -
Clinics in Geriatric Medicine Nov 2013Mild cognitive impairment (MCI) is an intermediate stage in the trajectory from normal cognition to dementia. Despite controversies about the classification of MCI,... (Review)
Review
Mild cognitive impairment (MCI) is an intermediate stage in the trajectory from normal cognition to dementia. Despite controversies about the classification of MCI, recent published criteria for MCI allow better comparison of the prevalence, incidence, and outcomes of MCI. Subjects with MCI have a high rate of progression to dementia over a relatively short period. In this review, we present an overview of the classification of MCI, estimates of the incidence and prevalence of MCI, risk factors for MCI, and the outcomes following an MCI diagnosis.
Topics: Aged; Cognitive Dysfunction; Dementia; Humans; Incidence; Prevalence; Risk Factors
PubMed: 24094295
DOI: 10.1016/j.cger.2013.07.003