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Special Article |

Current Concepts in Mild Cognitive Impairment

Ronald C. Petersen, MD, PhD; Rachelle Doody, MD, PhD; Alexander Kurz, MD; Richard C. Mohs, PhD; John C. Morris, MD; Peter V. Rabins, MD; Karen Ritchie, MPsych, PhD; Martin Rossor, MA, MDFRCP; Leon Thal, MD; Bengt Winblad, MD
Arch Neurol. 2001;58(12):1985-1992. doi:10.1001/archneur.58.12.1985.
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The field of aging and dementia is focusing on the characterization of the earliest stages of cognitive impairment. Recent research has identified a transitional state between the cognitive changes of normal aging and Alzheimer's disease (AD), known as mild cognitive impairment (MCI). Mild cognitive impairment refers to the clinical condition between normal aging and AD in which persons experience memory loss to a greater extent than one would expect for age, yet they do not meet currently accepted criteria for clinically probable AD. When these persons are observed longitudinally, they progress to clinically probable AD at a considerably accelerated rate compared with healthy age-matched individuals. Consequently, this condition has been recognized as suitable for possible therapeutic intervention, and several multicenter international treatment trials are under way. Because this is a topic of intense interest, a group of experts on aging and MCI from around the world in the fields of neurology, psychiatry, geriatrics, neuropsychology, neuroimaging, neuropathology, clinical trials, and ethics was convened to summarize the current state of the field of MCI. Participants reviewed the world scientific literature on aging and MCI and summarized the various topics with respect to available evidence on MCI. Diagnostic criteria and clinical outcomes of these subjects are available in the literature. Mild cognitive impairment is believed to be a high-risk condition for the development of clinically probable AD. Heterogeneity in the use of the term was recognized, and subclassifications were suggested. While no treatments are recommended for MCI currently, clinical trials regarding potential therapies are under way. Recommendations concerning ethical issues in the diagnosis and the management of subjects with MCI were made.

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Figure 1.

Theoretical progression of a person developing Alzheimer's disease (AD). The inflection point in the curve indicates the onset of mild cognitive impairment before the development of clinically probable AD. Reprinted with permission from W.B. Saunders.

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Figure 2.

Survival curve of persons characterized as having a mild cognitive impairment for 6 years. Approximately 80% have converted to dementia during this time. Reprinted with permission from John Wiley & Sons, Inc.

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Figure 3.

Comparison of the clinical diagnoses of normal aging, mild cognitive impairment (MCI), and Alzheimer's disease (AD), compared with the approximate stages on the rating scales, Clinical Dementia Rating (CDR) and Global Deterioration Scale (GDS). Adapted from the American Medical Association.13

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Figure 4.

Heterogeneity of the term mild cognitive impairment.

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