Mild Cognitive Impairment History and collateral are essential

History and collateral are essential
Physical examination helps with differential
Mental status, parkinsonism, neurologic deficits …
Consider screening tools:
MMSE – most commonly used
MoCA – detecting MCI
RUDAS – culturally/linguistically diverse
Mini-Cog – very quick (<3mins)

1. Outline
Objectives
Epidemiology
Clinical Assessment
Appropriate Investigations
Cognitive Impairment

2. Objectives
1.Differentiate normal aging from MCI and dementia
2.Be aware of criteria for MCI
3.Have an approach to treatment of MCI
1.Normal Memory for your age
May have minimal memory complaints but no objective
findings on clinical testing
2.Mild cognitive impairment
¡Cognitive complaints with objective testing in abnormal range
(MMSE, RUDAS, MoCA, etc) but no functional impact
3.Dementia (i.e ‘Major neurocognitive disorder’)
¡Cognitive complaints with functional decline

3. Dementia Stats
1-2% age 65
25% age 85+
Canada: ~500,000 individuals
US: ~7 million
Europe: ~10 million
Expect this to double in 20 years
Tremendous societal cost
Direct healthcare costs, lost income of patient and
caregiver

4. Clinical Assessment
History and collateral are essential
Physical examination helps with differential
Mental status, parkinsonism, neurologic deficits…
Consider screening tools:
MMSE – most commonly used
MoCA – detecting MCI
RUDAS – culturally/linguistically diverse
Mini-Cog – very quick (<3mins)

5. Situation 1
72F with memory concerns
Has begun misplacing keys and other items –
uses post-it notes to keep track
Caregiver confirms that she continues to manage
the family business without any problems
MoCA 25/30
Lost points: 1/5 delayed recall, 4/5 visuospatial
Diagnosis?

6. Mild Cognitive Impairment
Also known as Mild Neurocognitive Disorder?
Common
Approx 15% of individuals >70years old
Pathology suggests intermediate changes between
normal and AD
Estimates of progression to dementia
~10-15% annually
Concern regarding change in cognition
Impairment in one or more cognitive domains
Memory, executive function, attention, visuospatial,
language
Independent functional activities
Do not meet criteria for dementia

7. Effective Strategies
Physical Exercise
Cognitive Training (“Mental exercise”)
Socialization
Healthy Food Choices

8. Physical Exercise and
Cognition
Several studies showing benefit on cognition and
function
Meta-analysis (>2000 patients, 30 trials) – cognitive
function moderately improved
Evidence from high-quality RCTs is lacking

9. Brain Training
Quality of evidence limited but:
Consistent evidence of benefit
15 RCTs, >700 patients
Meta-analysis: Clear, consistent benefit on cognition
Some improvement in QoL and communication
Variety of cognitive training methods used

10. Socialization
Difficult area to formally study in scientific literature
Generally suggested and indirect evidence from
group exercises/activities that seem to benefit

11. Dietary Strategies
Several studies show benefit of Mediterranean-style
diet
MIND diet - Excellent data to support this
Very significantly reduced incidence and progression
of dementia

12. Other Nonpharm Strategies
There are many other nonpharm approaches with
proven effectiveness, including:
Optimizing sleep
Reviewing medications
Improving cardiovascular fitness
Assessing and managing sensory deficits (vision,
hearing, etc)
And many more that we explore in depth at Deter
Dementia

13. Recap
Differentiate normal aging from MCI and dementia
Cognitive testing and Functional status
1.
Be aware of criteria for MCI Cognitive changes with
functional independence
2.
Have an approach to treatment of MCI Nonpharm
strategies
3.