[Mild cognitive impairment as a heterogeneous condition: From diagnostic algorithm - to individualized therapeutic...

Mild cognitive impairment (MCI) is a prevalent syndrome affecting approximately 10-15% of the global population. In the Russian Federation, the estimated number of individuals with MCI may reach 5 million, with continued growth projected. Subjective cognitive deficits are linked to an increased risk of dementia, although memory complaints are often regarded as a normal aspect of aging. Standard neuropsychological assessments, including the Mini-Mental State Examination (MMSE), Mini-Cog, and Montreal Cognitive Assessment (MoCA), often lack sufficient sensitivity to detect MCI, particularly in individuals with high cognitive reserve. MCI has multiple etiologies, including depression and other affective disorders, severe somatic diseases, traumatic or toxic brain injury, and neurodegenerative or vascular pathologies of the central nervous system. This etiological diversity leads to variable clinical outcomes: cognitive function may return to age-appropriate norms in some instances, while in others, early impairment progresses to dementia. High-risk factors for conversion from MCI to dementia include the amnestic subtype of cognitive impairment, slow gait, coexisting affective disorders, sensory deficits, senile preasthenia and asthenia, and sleep disturbances. Accurate prediction of disease progression is critical for informing therapeutic strategies. For patients at elevated risk of progression, pharmacological interventions should be selected not only for symptomatic management but also for their potential to delay conversion. In Russia, Miladean, a combination of memantine and melatonin, is approved for use in patients with MCI. In addition to its symptomatic benefits, Miladean exhibits neuroprotective and endothelioprotective properties, supporting its use as the preferred treatment for patients at high risk of MCI progression.