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MRI identifies MCI subtypes: vascular versus neurodegenerative
John S Meyer1, Minh Quach, John Thornby
1Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA. jmeyer@bcm.tmc.edu
Abstract:
As life expectancy increases worldwide, pandemics of cognitive impairment and dementia are emerging as major public health problems. Mild cognitive impairment (MCI), prodromal for dementia, is a descriptive term used for those clinical states showing early and subtle cognitive decline among the elderly, preceding the dementias. Psychometric screening combining Mini-Mental Status (MMSE) and Cognitive Capacity Screening (CCSE) Examinations, when combined now called CMC with C standing for Combined, M for MMSE, and C for CCSE, confirms diagnosis of MCI. Individuals identified with MCI are at increased risk for dementia of Alzheimer's type (DAT), vascular dementia (VAD) and other rare neurodegenerative dementias, including Lewy body dementia (LBD), fronto-temporal dementia (FTD) and Parkinson's disease dementia (PDD). Depending on different clinical compositions of cohorts studied, and MCI criteria used, between 19% and 50% of MCI progress to dementia within 3-5 years, two thirds to Alzheimer's (DAT) and one third to vascular types (VAD) in the United States. Not all Parkinsonians become demented, but PDD develops in 20-30%, however, PDD subjects were excluded from the present study, as were LBD and FTD. The incidence of MCI in those over age 70, with confirmed cognitive declines when tested 2 years later, is around 23%, but some spontaneously improve.
Insights
Mild cognitive impairment (MCI) affects the elderly and precedes dementia. Early diagnosis using combined screening (MMSE and CCSE) identifies individuals at risk for Alzheimer's and vascular dementia.
Area of Science:
- Gerontology
- Neurology
- Public Health
Background:
- Global life expectancy increases, leading to a rise in cognitive impairment and dementia.
- Mild cognitive impairment (MCI) represents an early, subtle cognitive decline in the elderly, often preceding dementia.
- MCI increases the risk for various dementia types, including Alzheimer's disease and vascular dementia.
Purpose of the Study:
- To highlight the public health significance of cognitive impairment and dementia in aging populations.
- To introduce a combined screening method (CMC) for diagnosing MCI.
- To discuss the progression rates of MCI to different dementia subtypes.
Main Methods:
- Utilized psychometric screening combining the Mini-Mental Status Examination (MMSE) and Cognitive Capacity Screening Examination (CCSE), termed CMC.
- Identified individuals with MCI, noting their increased risk for dementia.
- Reviewed progression rates of MCI to dementia (Alzheimer's and vascular types) based on existing literature.
Main Results:
- The combined screening (CMC) aids in confirming MCI diagnosis.
- Between 19% and 50% of MCI cases progress to dementia within 3-5 years.
- In the US, two-thirds of MCI progress to Alzheimer's dementia and one-third to vascular dementia.
Conclusions:
- MCI is a critical prodromal stage for dementia, necessitating early detection.
- The CMC screening method offers a valuable tool for identifying individuals with MCI.
- Understanding MCI progression is crucial for developing targeted interventions and managing public health challenges associated with dementia.
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