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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Parkinson's and Alzheimer's diseases: Focus on mild cognitive impairment
1Department of Neurology, Tel Aviv University Medical School, Ramat Aviv 69978, Israel.
Abstract:
The mild cognitive impairment (MCI) concept was developed to identify the earliest stages of cognitive impairment. MCI and, more specifically, amnestic MCI were initially proposed as transitional states that ultimately progress to full blown Alzheimer's disease (AD). However, MCI subjects do not uniformly progress to dementia (either AD or another) and may revert back to normal cognitive state. The MCI as concept has been borrowed from AD to other neurodegenerative diseases, particularly Parkinson's disease (PD). However the operational definition of MCI may not adequately convey the intended concept. Additional modifications to the concept and its operationalization are needed in order to better identify patients with incipient cognitive impairment and to guide clinical and research practices. Patients with PD have a very high likelihood of developing dementia, insidiously over many years. Cognitive impairment may start even before other symptoms. No constellation of cognitive symptoms in an otherwise healthy individual will herald development of AD or indeed will progress to dementia, including PD-dementia, in high likelihood. At present, identification of subtle cognitive dysfunction even in a person with diagnosed PD does not benefit the patient and should be avoided, except for research purposes.
Insights
Mild cognitive impairment (MCI) definitions need refinement, especially when applied to neurodegenerative diseases like Parkinson's disease (PD). Current diagnostic criteria may not accurately identify early cognitive changes in PD patients.
Area of Science:
- Neurology
- Neuroscience
- Cognitive Science
Background:
- The concept of Mild Cognitive Impairment (MCI) was established to detect early cognitive decline, often considered a precursor to Alzheimer's disease (AD).
- However, the progression of MCI to dementia is not uniform, with some individuals reverting to normal cognition.
- The MCI construct has been extended to other neurodegenerative conditions, including Parkinson's disease (PD).
Purpose of the Study:
- To evaluate the applicability and limitations of the current Mild Cognitive Impairment (MCI) concept in the context of Parkinson's disease (PD).
- To highlight the need for revised operational definitions of MCI for better identification of incipient cognitive impairment in neurodegenerative diseases.
- To guide clinical and research practices concerning cognitive assessment in PD.
Main Methods:
- Review and critical analysis of existing literature on Mild Cognitive Impairment (MCI) and its application in Alzheimer's disease (AD) and Parkinson's disease (PD).
- Examination of the diagnostic criteria and progression patterns of cognitive impairment in PD.
- Conceptual analysis of the utility and challenges of applying the MCI construct to PD.
Main Results:
- The progression of MCI to dementia is variable, and MCI does not always indicate future cognitive decline.
- Parkinson's disease (PD) patients exhibit a high likelihood of developing dementia, often with insidious cognitive changes preceding motor symptoms.
- The current operational definition of MCI may not be sufficiently precise for accurately identifying cognitive impairment in PD.
Conclusions:
- The existing definition of Mild Cognitive Impairment (MCI) requires modification to effectively identify early cognitive dysfunction in Parkinson's disease (PD).
- Current cognitive assessments in PD patients, outside of research, offer limited clinical benefit.
- Refined diagnostic approaches are crucial for advancing research and clinical management of cognitive impairment in neurodegenerative diseases.
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