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Multiple cognitive deficits in amnestic mild cognitive impairment
Joel H Kramer1, Adam Nelson, Julene K Johnson
1San Francisco Medical Center, University of California, San Francisco, CA 94143, USA. kramer@itsa.ucsf.edu
Objective:
To determine if more widespread cognitive deficits are present in a narrowly defined group of patients with the amnestic form of mild cognitive impairment (MCI).
Methods:
From a larger sample of patients clinically diagnosed as meeting the criteria of Petersen et al. for amnestic MCI, we selected 22 subjects who had Clinical Dementia Rating scores of zero on all domains besides memory and orientation. These MCI subjects with presumably isolated memory impairments were compared to 35 age-matched normal controls and 33 very mild Alzheimer's disease (AD) patients on a battery of neuropsychological tests.
Result:
In addition to the expected deficits in episodic memory, the amnestic MCI group performed less well than the controls but better than the AD group on design fluency, category fluency, a set shifting task and the Stroop interference condition. Over half the amnestic MCI group (vs. none of the normal controls) scored at least 1 standard deviation below control means on 4 or more of the nonmemory cognitive tasks.
Conclusions:
Isolated memory impairment may be fairly uncommon in clinically diagnosed amnestic MCI patients, even when the criteria for amnestic MCI are fairly narrow. Additional cognitive impairments are likely to include fluency and executive functioning. These more diffuse deficits argue for comprehensive cognitive assessments, even when the patient and family are reporting only memory decline, and are consistent with the increase in attention paid to the heterogeneity of MCI.
Insights
Even with narrow criteria, amnestic mild cognitive impairment (MCI) patients often show non-memory cognitive deficits, including executive functioning and fluency issues. Comprehensive cognitive assessments are recommended for these individuals.
Area of Science:
- Neuropsychology
- Cognitive Neurology
Background:
- Mild cognitive impairment (MCI) is a transitional stage between normal aging and dementia.
- Amnestic MCI is characterized by isolated memory complaints, but the extent of other cognitive deficits is debated.
Purpose of the Study:
- To investigate the presence of broader cognitive deficits in a strictly defined group of patients with amnestic MCI.
- To compare cognitive performance in amnestic MCI patients with normal controls and very mild Alzheimer's disease (AD).
Main Methods:
- Selected 22 amnestic MCI patients meeting specific criteria (Petersen et al.) with zero non-memory Clinical Dementia Rating scores.
- Compared MCI subjects to 35 age-matched normal controls and 33 very mild AD patients.
- Administered a comprehensive battery of neuropsychological tests.
Main Results:
- Amnestic MCI patients exhibited deficits in episodic memory, as expected.
- The MCI group also showed impairments in design fluency, category fluency, set shifting, and Stroop interference compared to controls.
- Over half of the MCI participants scored significantly below controls on multiple non-memory cognitive tasks.
Conclusions:
- Isolated memory impairment is uncommon in clinically diagnosed amnestic MCI, even with narrow criteria.
- Fluency and executive functioning deficits are frequently observed alongside memory issues in amnestic MCI.
- These findings support the need for thorough cognitive evaluations in MCI patients, acknowledging the heterogeneity of the condition.
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