Basic Behavioral Neurology Clinical Concepts

Mild cognitive impairment definitions

- Alzheimer Disease Research Center (ADRC) criteria (Albert et al, 2011)

1) Concern regarding an intraindividual change in cognition

2) Impairment in one or more cognitive domains

3) Preservation of independence in functional abilities

4) Not demented

- Petersen criteria (Petersen 2016)

1) Memory complaints per subject and/or collateral source

2) Intact activities of daily living

3) Clinical dementia rating scale of 0.5

4) Performance on a delayed memory test that is at least one standard deviation below the mean for the subject’s age

- Epidemiology (Petersen 2016)

1) 15-20% of patients over the age of 60 have MCI

2) The annual rate in which MCI progresses to dementia varies between 8% and 15% per year

Levels of Functioning (Salardini 2019)

- Activities of daily living: dressing, bathing, toileting, continence, transferring, eating

- Instrumental activities of daily living: shopping, preparing food, housework, laundry, use transportation, medication compliance, handling finances

- Advanced activities of daily living: vocational skills, vocational knowledge, hobby-related mastery, music, art

Dementia definition (McKhann 2011)

Cognitive or behavioral (neuropsychiatric) symptoms that:

1) Interfere with the ability to function at work or at usual activities; and

2) Represent a decline from previous levels of functioning and performing; and

3) Are not explained by delirium or major psychiatric disorder.

4) Cognitive impairment is detected and diagnosed through a combination of

- History-taking from the patient and a knowledgeable informant and

- Objective cognitive assessment, either a “bedside” mental status examination or neuropsychological testing

5) The cognitive or behavioral impairment involves a minimum of two of the following domains:

- Impaired ability to acquire and remember new information

- Impaired reasoning and handling of complex tasks, poor judgment

- Impaired visuospatial abilities

- Impaired language functions

- Changes in personality, behavior, or comportment

References

Albert, M. S. 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. 7, 270–279 (2011) https://pubmed.ncbi.nlm.nih.gov/21514249/

McKhann, G. M. 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. 7, 263–269 (2011). https://pubmed.ncbi.nlm.nih.gov/21514250/

Petersen, R. C. Mild Cognitive Impairment. Continuum 22, 404–18 (2016) https://pubmed.ncbi.nlm.nih.gov/27042901/

Salardini, A. An Overview of Primary Dementias as Clinicopathological Entities. Semin. Neurol. 39, 153–166 (2019). https://pubmed.ncbi.nlm.nih.gov/30925609/