Neurology Book



Mild Cognitive Impairment

Aka: Mild Cognitive Impairment, Significant Forgetfulness
  1. See Also
    1. Dementia
  2. Diagnosis
    1. Complaint of Memory Loss and impaired for age
      1. Significant Forgetfulness
    2. Does not meet criteria for Dementia
      1. Normal general cognitive functioning
      2. Normal Activities of Daily Living
  3. Differential Diagnosis
    1. See Altered Level of Consciousness Causes
    2. See Dementia Causes
    3. See Toxin Induced Neurologic Changes
    4. See Beer's List (esp. Benzodiazepines, Anticholinergic Medications)
    5. Dementia
    6. Major Depression
    7. Chemical Dependency
    8. Vitamin B12 Deficiency
  4. Evaluation
    1. See Mental Status Exam
    2. Routine screening of asymptomatic older patients is not currently recommended by USPTF
      1. Moyer (2014) Ann Intern Med 160:291-7 [PubMed]
  5. Diagnostics
    1. MRI may show Amygdala degeneration (in cases at higher risk of progression to Dementia)
  6. Management
    1. Lifestyle interventions may be helpful
      1. Encourage mentally stimulating activities
      2. Unclear efficacy of mentally challenging puzzles (e.g. crossword puzzles, Soduko), but may be helpful
      3. Encourage social engagement
      4. Increase Physical Activity
      5. Address Cardiac Risk Factors
    2. Avoid medications
      1. Avoid using Cholinesterase Inhibitors or Nemenda for Mild Cognitive Impairment
        1. Associated with adverse effects without evidence of benefit
      2. No evidence for consistent benefit from any herbal supplement (e.g. ginkgo, coconut oil)
  7. Course
    1. Improves spontaneously in up to 50% of cases
    2. May ultimately progress with age to Alzheimer's Dementia
      1. Progresses in 5-10% of patients/year compared with 1-2% without Mild Cognitive Impairment
  8. References
    1. Cooper (2013) Br J Psychiatry 203:255-64 [PubMed]
    2. Peterson (2011) N Engl J Med 364:2227-34 [PubMed]

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