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State of the science on mild cognitive impairment (MCI)

Nicole D Anderson¹

¹Departments of Psychology and Psychiatry,University of Toronto,Rotman Research Institute,Baycrest Health Sciences,Toronto,Ontario,Canada.

|January 18, 2019

Abstract:

Mild cognitive impairment (MCI) represents a transitional stage between healthy aging and dementia, and affects 10-15% of the population over the age of 65. The failure of drug trials in Alzheimer's disease (AD) treatment has shifted researchers' focus toward delaying progression from MCI to dementia, which would reduce the prevalence and costs of dementia profoundly. Diagnostic criteria for MCI increasingly emphasize the need for positive biomarkers to detect preclinical AD. The phenomenology of MCI comprises lower quality-of-life, greater symptoms of depression, and avoidant coping strategies including withdrawal from social engagement. Neurobiological features of MCI are hypoperfusion and hypometabolism in temporoparietal cortices, medial temporal lobe atrophy particularly in rhinal cortices, elevated tau and phosphorylated tau and decreased Aβ42 in cerebrospinal fluid, and brain Aβ42 deposition. Elevated tau can be identified in MCI, particularly in the entorhinal cortex, using positron emission tomography, and analysis of signal complexity using electroencephalography or magnetoencephalography holds promise as a biomarker. Assessment of MCI also relies on cognitive screening and neuropsychological assessment, but there is an urgent need for standardized cognitive tests to capitalize on recent discoveries in cognitive neuroscience that may lead to more sensitive measures of MCI. Cholinesterase inhibitors are frequently prescribed for MCI, despite the lack of evidence for their efficacy. Exercise and diet interventions hold promise for increasing reserve in MCI, and group psychoeducational programs teaching practical memory strategies appear effective. More work is needed to better understand the phenomenology and neurobiology of MCI, and how best to assess it and delay progression to dementia.

Insights

Mild cognitive impairment (MCI) is a stage between aging and dementia. Research focuses on biomarkers and interventions to delay its progression to Alzheimer's disease (AD).

Area of Science:

Neurology
Neuroscience
Gerontology

Background:

Mild cognitive impairment (MCI) affects 10-15% of individuals over 65, representing a critical transitional phase toward dementia.
Alzheimer's disease (AD) drug trial failures necessitate a shift towards delaying MCI progression to reduce dementia prevalence and healthcare costs.
Current MCI diagnostics increasingly require positive biomarkers for preclinical AD detection, alongside cognitive assessments.

Purpose of the Study:

To review the phenomenology, neurobiology, assessment methods, and potential interventions for mild cognitive impairment (MCI).
To highlight the need for improved diagnostic tools and strategies to delay the progression of MCI to dementia.
To discuss the current understanding and future directions in managing MCI.

Main Methods:

Review of current literature on MCI phenomenology, neurobiology, and diagnostic criteria.
Analysis of neuroimaging (PET, EEG, MEG) and cerebrospinal fluid (CSF) biomarkers for MCI detection.
Evaluation of existing and potential interventions, including pharmacological, lifestyle, and psychoeducational approaches.

Main Results:

MCI is characterized by reduced quality-of-life, depression, and social withdrawal.
Neurobiological hallmarks include temporoparietal hypoperfusion, medial temporal lobe atrophy, and altered CSF Aβ42 and tau levels.
Positron emission tomography (PET) for tau and electroencephalography (EEG)/magnetoencephalography (MEG) signal complexity show promise as biomarkers.

Conclusions:

There is an urgent need for standardized cognitive tests and validated biomarkers to accurately assess MCI and detect preclinical AD.
While cholinesterase inhibitors are used, lifestyle interventions (exercise, diet) and psychoeducational programs show promise in enhancing cognitive reserve.
Further research is essential to fully elucidate MCI's phenomenology and neurobiology for effective dementia prevention strategies.

Read full analysis

Keywords:

Amyloid biomarkers exercise and diet interventions memory strategy training mild cognitive impairment neuroimaging neuropsychological assessment tau

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