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Mild cognitive impairment
The document discusses mild cognitive impairment (MCI) as an acquired cognitive disturbance that does not hinder daily functioning, highlighting the prevalence of MCI among older adults and its relationship with Alzheimer’s disease (AD). It presents various cognitive tests, biomarkers for MCI, and preventive strategies, emphasizing the role of lifestyle factors such as exercise and diet in mitigating risks. The Mediterranean diet and addressing sleep apnea are also noted as beneficial for brain health.
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Mild cognitive impairment
- 1. Click to AddTitle Click to Add Subtitle Mild Cognitive Impairment Spectrum Monica K. Crane, MD Director of Clinical Research Associate Director, Cole Neuroscience Center Clinical Assistant Professor of Medicine Dept. of Medicine
- 2. Disclosures • Board member of Alzheimer’s Tennessee • Founding member of the International Society of Frontotemporal dementia •Grant/Research support: Biogen, Eisai. 2
- 3. Cognitive Aging isnot a disease www.iom.edu/cognitive aging 2015
- 4. Cognitive Aging • Everyone is affected. •Thinking can improve with aging. • Intact adults can strengthen some cognitive abilities. www.iom.edu/cognitive aging 2015
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- 8. • Symptom nota diagnosis • 100+ types • Never normal in aging Dementia Umbrella term
- 9. Mild Cognitive Impairment (MCI) An acquired disturbancein cognition without impairment in daily functioning.
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- 11. Who has MCI? Dickerson.Advances in quantitative magnetic resonance imaging-based biomarkers for Alzheimer disease. Alzheimer's Research & Therapy 2010; 2:21 Meyer et al. Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People. Arch Neurol 2010;67:949-956. 10-20% of those aged 65+ older may have MCI.
- 12. Am I onthe TIMELINE?
- 13. • Clinically “normal”range but may have patterns or positive biomarker for AD. • Treated as “worried well” depressed, anxious, etc. Dickerson. Advances in quantitative magnetic resonance imaging-based biomarkers for Alzheimer disease. Alzheimer's Research & Therapy 2010; 2:21 Meyer et al. Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People. Arch Neurol 2010;67:949-956. What is preclinical or pre-MCI?
- 14. Criteria for Probable MCI due to AD • Meets criteria for MCI –History and physical, labwork –Cognitive screens • Impaired for age and education •Clinical Dementia Rating Score of 0.5 • Computer Self Test (CST) of 27 or less • MOCA of 26 or less • and an objective biomarker: Dickerson. Advances in quantitative magnetic resonance imaging-based biomarkers for Alzheimer disease. Alzheimer's Research & Therapy 2010; 2:21 Meyer et al. Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People. Arch Neurol 2010;67:949-956.
- 15. Dickerson. Advances inquantitative magnetic resonance imaging-based biomarkers for Alzheimer disease. Alzheimer's Research & Therapy 2010; 2:21 Meyer et al. Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People. Arch Neurol 2010;67:949-956.
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- 17. 17 • 9/5/2013 • 70 yo female memory concerns. •Diagnosis: MCI amnestic variant • MOCA 24 • Able to work.
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- 20. Diagnosis of >90% clinical accuracy? • Biomarker is objective measure used as evidence of a biological or pathological process • We use biomarkers daily in practice Dickerson.Advances in quantitative magnetic resonance imaging-based biomarkers for Alzheimer disease. Alzheimer's Research & Therapy 2010; 2:21 Meyer et al. Diagnosis-Independent Alzheimer Disease Biomarker Signature in Cognitively Normal Elderly People. Arch Neurol 2010;67:949-956.
- 21. Biomarkers for MCI due to AD • Anatomy • Functionalor metabolic change (downstream) • Pathology – CSF Aβ-42 – CSF tau / phospho- tau – PET amyloid imaging – Tau imaging Additional IMAGING American Academy of Neurology guidelines. Arora A, Bhagat N. Insight into the Molecular Imaging of Alzheimer's Disease. Int J Biomed Imaging. 2016
- 22. Foster DJ, WilsonMA. Nature 2006;440:680-683. Foster DJ, Knierim JJ. Curr Opinion Neurobiol 2012;22:294-300. Biomarker: Hippocampus • Working memory • Planning and imagination • Must be intact to imagine the “what ifs”…
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- 25. Amyloid PET to show plaque Acta Neuropathol Commun.2014; 2: 46. 2014 Apr 22.
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- 27. FIXED risk factors for MCI due to AD • Age • Family history 1°relatives • Genetics • Subjective memory impairment
- 28. • Lack of exercise • Midlifeobesity • Low education • Smoking • Hypertension • Diabetes • Depression • Sleep Apnea 7 FIXABLE RISK FACTORS 1/3 of current AD cases are from these 7 factors PAR, population attributable risk. Courtesy of Lancet Neurol. 2011 Sep; 10(9): 819–828.
- 30. Exercise slows MCI due to AD • Slows decline on testing and on functional MRI. • Slows conversion to AD JCSmith et al. Semantic Memory Functional MRI and Cognitive Function After Exercise Intervention in Mild Cognitive Impairment. Journal of Alzheimer’s Disease, 2013
- 31. • Lack of exercise • Midlifeobesity • Low education • Smoking • Hypertension • Diabetes • Depression • New risk factors 7+ risk factors for Alzheimer’s that you can modify 1/3 of current AD cases are from these 7 factors PAR, population attributable risk. Courtesy of Lancet Neurol. 2011 Sep; 10(9): 819–828.
- 32. Protective activities reduce MCI (median age 87.3) • Art and crafts • Social groups (volunteer, church, group educational activities) •Second language • Musical instrument/ choir • Computer (ONLY for 80+) Roberts RO et al. Neurology 2015 Apr 8. Galvin JE. Neurology 2014 Apr 8.
- 33. • Lack of exercise • Midlifeobesity • Low education • Smoking • Hypertension • Diabetes • Depression • New risk factors 7+ risk factors for Alzheimer’s that you can modify 1/3 of current AD cases are from these 7 factors PAR, population attributable risk. Courtesy of Lancet Neurol. 2011 Sep; 10(9): 819–828.
- 34. What diet isgood for the brain???
- 35. Mediterranean diet • Nuts, complex grains, olive oil • Fruits and vegetables •Coffee and Tea • Omega-3 fats. – Salmon, tuna, trout, sardines, seafoods. • Avoid refined sugars, red meat and processed foods – Sugary desserts, baked goods – Red meat, fast food, “diet” food www.rand.org Meta-analysis 1.5 million people, 35 studies: Mediterranean diet decreased risk of dementia death by 13%
- 36. • Lack of exercise • Midlifeobesity • Low education • Smoking • Hypertension • Diabetes • Depression • New risk factors 7+ risk factors for Alzheimer’s that you can modify 1/3 of current AD cases are from these 7 factors PAR, population attributable risk. Courtesy of Lancet Neurol. 2011 Sep; 10(9): 819–828.
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