Introduction     Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D.     Defining Alzheimer's Disease       Evaluating Patients       Pre-Dementia Impairment       Mild Cognitive Impairment       Treatment Strategies for Dementia and Mild Cognitive Impairment Mary Sano, Ph.D.     Treatment of Depression, Agitation, and Psychosis in Dementia Davangere P. Devanand, M.D.     Recognition of Vascular Dementia, Dementia with Lewy Bodies, and Frontotemporal Dementia Lawrence S. Honig, M.D., Ph.D.     Neuropsychology of Mild Cognitive Impairment, Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia Penne Sims, Ph.D.     Neuroimaging in Dementia Scott A. Small, M.D.     Genetics of Neurodegenerative Disease: Alzheimer's Disease, Frontotemporal Dementia Jennifer Williamson-Catania, M.S.     Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq.     Posttest         Accreditation     Reference List     Acknowledgements		Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D. Pre-Dementia Impairment   Every physician has patients in his or her practice who complain of memory problems. Some of those people have anxiety, a depressed mood, or, as is typical with older people, have some sort of sensory impairment. How can we tell what is normal and what is not?   When there is a self-report of major memory problems, there is probably something wrong. Studies have shown that having a patient's informant confirm memory problems correlates with an objective deficit on testing. Peter Schofield at Columbia showed that patients who developed new memory complaints since the previous visit had a predicted decline on cognitive measures.   The common causes of impaired cognition include some medications, such as anticholinergics, some psychotropics, and some anti-hypertensives, and comorbid conditions like infections and depression in older people.   Many of the scales we use for rating cognitive impairment include categories prior to dementia. It may be the case that patients in these categories are at risk for progressing to dementia. On the Global Deterioration Scale (GDS), stages two and three correspond to some deficits that may correlate with the impairment that occurs before dementia. On the Clinical Dementia Rating (CDR) scale, a rating of 0.5 corresponds to questionable dementia, with some impairment in the six domains of memory, orientation, judgment and problem solving, function in community affairs, home and hobbies, and personal care. This may mark the pre-dementia state.     PREVIOUS | NEXT