What is mild cognitive impairment

"Mild cognitive impairment" an obligatory preliminary stage of dementia? - Not correct!

The "slight cognitive impairment" (English mild cognitive impairment [MCI]) is essentially characterized by a reduced memory performance without further behavioral problems in older people - often referred to as old age forgetfulness. According to available scientific evidence, it is said to have a prevalence of 16% and an incidence of 63.6 per 1000 person-years.

In particular, the protagonists of the reinvention and commercialization of disease (a strategy known in English as disease mongering is referred to) never tire of portraying MCI as an obligatory preliminary stage of later dementia. Analogous examples are pre-hypertension, prediabetes and, here, pre-dementia ... (more are sure to follow). Accordingly, various medicinal therapies are recommended, all of which have so far failed in preventing the development of dementia.

After the MCI with the new inclusion in the recently published fifth edition of the psychiatric diagnosis Bible Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been upgraded to a disease, the insecure patients and their (house) doctors are more urgent than ever to ask what course these impairments will take.

Under the direction of Hanna Kaduszkiewicz (Head of the Department of General Medicine at the University of Kiel) a publication has just appeared that deals with the prognosis of MCI in primary care patients.

From a total of 3,327 general practitioner patients, 375 people with symptoms of MCI aged at least 75 years (mean age almost 80 years) were included in the study. Depending on the course of the impairment over the observation period, the symptoms were retrospectively classified into

this order reflects an increasingly poor prognosis.

The study participants were visited by trained interviewers at the beginning and after 18 and 36 months and assessed using five instruments (SIDAM, Mini-Mental-State, CERAD test battery, watch test and Geriatric Depression Scale to investigate possible depression; For details see Kaduszkiewicz et al. 2014).

Anyone who has now thought that at least the majority of patients would develop dementia is mistaken by the results:

  • 41.5% had remission and returned to an age-appropriate normal cognitive status.
  • 21.3% showed a fluctuating course, i.e. at the end of the three-year observation period they were either back to normal or still had an MCI.
  • 14.8% had a constant MCI and
  • 22.4% progressed to dementia.

Quintessence: Over three-quarters of elderly patients with mild cognitive impairment either remain stable (at least within three years) or return to normal performance.

Kaduszkiewicz H, Eisele M, Wiese B, et al. Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study. Ann Fam Med 2014; 12: 158-165. Free at annfammed.org/content/12/2/158.full

(Status: 02/19/2015)