5-Minute Clinical Consult

Mild Cognitive Impairment

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Basics

Description

  • Mild cognitive impairment (MCI) is defined as significant cognitive impairment in the absence of dementia, as measured by standard memory tests:
    • Concern regarding change in cognition
    • Preservation of independence in functional activities (activities of daily living (ADLs)
    • Impairment in ≥1 cognitive domains (attention, executive dysfunction, memory, visuospatial, language) (1)[B]
    • Other terms used in the literature relating to MCI: Isolated memory impairment; cognitive impairment not dementia (CIND); predementia; mild cognitive disorder; age-associated memory impairment; age-related cognitive decline; benign senescent forgetfulness. Some of these conditions do not progress to dementia (i.e., benign senescent forgetfulness, age-associated memory impairment, age-related cognitive decline).
  • Annual rates of conversion of MCI to dementia are 2–15% in the elderly.

Epidemiology

Incidence
  • Predominant sex: Male > Female
  • Predominant age:
    • Higher in older persons and in those with less education
    • 12–15/1,000 person-years in those age ≥65 years
    • 54/1,000 person-years in those age ≥75 years

Prevalence
  • MCI is more prevalent than dementia in the US.
  • 3–5% for those age ≥60 years
  • 15% for those age ≥75 years

Etiology and Pathophysiology

  • Subtypes of MCI:
    • Single-domain amnestic
    • Multiple-domain amnestic
    • Nonamnestic single-domain
    • Nonamnestic multiple-domain
  • The amnestic subtype is higher risk for progression to Alzheimer disease (2)[A].
  • Vascular, degenerative, traumatic, metabolic, psychiatric, or a combination

Genetics
Apolipoprotein (APO) E4 genotype: Various pathways exist leading to amyloid accumulation and deposition thought to be associated with dementia.

Risk Factors

  • Age
  • Diabetes
  • Hypertension
  • Hyperlipidemia
  • Cerebrovascular disease
  • Smoking
  • Sleep apnea
  • APO E4 genotype

Commonly Associated Conditions

See “Risk Factors.”

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