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. Mild Cognitive Impairment   Mild cognitive impairment (MCI), though different from normal, is not a disease. Some think it is a transitional state between normal aging and dementia. There are different types of MCI. There may be cognitive impairment in multiple areas of cognitive function, in addition to memory. In some cases, memory is normal but some other domain of cognitive function is abnormal.   Amnestic MCI appears to be a risk state for the development of Alzheimer's disease. Amnestic impairment is defined by subjective memory complaints. These patients have poor memory performance for their age and education on formal testing when compared to age-matched peers. General cognitive functions and the ability to perform the activities of daily living should be entirely normal. The amnestic type of MCI is associated with hippocampal atrophy, neurofibrillary tangles in the medial temporal lobes, and elevated levels of Tau in the cerebrospinal fluid (CSF).   In a comparison of series of those with MCI to Alzheimer's disease subjects and controls, Alzheimer's and MCI groups were alike on memory measures and were differentiated by impairment in other areas of cognitive function. In most series of amnestic MCI cases, 10 to 15 percent per year progress to dementia. It is important to know, however, that one in four patients do not convert and remain with MCI. Among normal patients, 1 to 2 percent per year convert to dementia and 5 percent convert over five years.         Mild Cognitive Impairment   In most series of amnestic MCI cases, 10 to 15 percent per year progress to dementia while 25 percent do not convert and remain with MCI. Courtesy of Dr. Karen Bell     Delayed recall is an important indicator to a physician. It is the best predictor of subsequent dementia in the non-demented elderly, as well as of subsequent Alzheimer's diseases in memory-impaired patients. It is the best discriminator between normal aging and mild Alzheimer's. The American Academy of Neurology established practice guidelines for MCI evaluation and recommended having an increased awareness of this condition. An informant-based interview is just as important when you are evaluating for dementia, and you should consider using general screening tests like the MMSE. Neuropsychological tests can also be useful, but be cautious when using brief focused screening such as the clock-drawing test (CDT). In summary, it is important to have a high index of suspicion of cognitive impairment for those with memory complaints. Identify everyone who is at risk for developing Alzheimer's disease and follow them closely. These patients are likely to be eligible for prevention studies, and earlier treatment has been shown to be beneficial.     PREVIOUS | NEXT