Mild Cognitive Impairment: Diagnosis and Subtypes
Abstract
Mild cognitive impairment (MCI) is a clinical diagnosis based on subjective cognitive decline, objective cognitive impairment, and relative preservation of activities of daily living. The diagnosis may be established via clinical interview, collateral history from an informant, and psychometric examination. Various consensus groups have proposed criteria for MCI in Alzheimer's disease (AD), Parkinson's disease, dementia with Lewy bodies, and vascular cognitive impairment. These diagnostic criteria have subtle but important differences. Criteria for subjective decline vary according to whether memory is impaired or whether impairment in any cognitive domain is sufficient. There are also differences with respect to whether the subjective decline is noted by the patient, a carer, or a clinician. The precise thresholds for classifying objective cognitive impairment also vary between various diagnostic criteria. There are also differences in the description of functional abilities. Once established, the diagnosis of MCI may be refined to 1 of 4 subtypes based on the pattern of cognitive impairment. The 4 subtypes are defined according to whether or not memory is impaired and whether 1 or more cognitive domains are impaired. Once a diagnosis of MCI has been made, the patient and the family should be counseled about social and legal implications as well as strategies for reducing the risk of progression to dementia. The main utilities of MCI as a nosology are to understand the natural history of neurodegenerative disorders such as AD, to identify those at increased risk of progressing to develop dementia, and to identifying individuals for putative treatments.
Get full access to this article
View all access and purchase options for this article.
References
1. Alzheimer's Association. 2013. Alzheimer's disease facts and figures. Alzheimer’s Demen. 2013;9:208-245.
2. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673-2734.
3. Villemagne VL, Burnham S, Bourgeat P, et al. Amyloid β deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer's disease: a prospective cohort study. Lancet Neurol. 2013;12(4):357-367.
4. Hardy J, Allsop D. Amyloid deposition as the central event in the aetiology of Alzheimer's Disease. Trends Pharmacol Sci. 1991;12(10):383-388.
5. The Lancet Neurology. Solanezumab: too late in mild Alzheimer's disease? Lancet Neurol. 2017;16(2):97.
6. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256(3):183-194.
7. Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the national institute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer’s Demen. 2011;7(3):270-279.
8. Kral V. Senescent forgetfulness: benign and malignant. Can Med Assoc J. 1962;86(6):257-260.
9. Bradfield NI, Ames D. Mild cognitive impairment: narrative review of taxonomies and systematic review of their prediction of incident Alzheimer's disease dementia. BJPsych Bull. 2020;44(2):67-74.
10. Mitchell AJ, Shiri-Feshki M. Rate of progression of mild cognitive impairment to dementia—meta-analysis of 41 robust inception cohort studies. Acta Psychiatr Scand. 2009;119(4):252-265.
11. Koepsell TD, Monsell SE. Reversion from mild cognitive impairment to normal or near-normal cognition: risk factors and prognosis. Neurology. 2012;79(15):1591-1598.
12. Gao Q, Gwee X, Feng L, et al. Mild cognitive impairment reversion and progression: rates and predictors in community-living older persons in the Singapore longitudinal ageing studies cohort. Dement Geriatr Cogn Dis Extra. 2018;8(2):226-237.
13. Shimada H, Doi T, Lee S, Makizako H. Reversible predictors of reversion from mild cognitive impairment to normal cognition: a 4-year longitudinal study. Alzheimer’s Res Ther. 2019;11(1):24.
14. Overton M, Pihlsgård M, Elmståhl S. Diagnostic stability of mild cognitive impairment, and predictors of reversion to normal cognitive functioning. Dement Geriatr Cogn Disord. 2019;48(5):317-329.
15. Litvan I, Goldman JG, Tröster AI, et al. Diagnostic criteria for mild cognitive impairment in Parkinson's disease: movement disorder society task force guidelines. Mov Disord. 2012;27(3):349-356.
16. McKeith IG, Ferman TJ, Thomas AJ, et al. Research criteria for the diagnosis of prodromal dementia with Lewy bodies. Neurology. 2020;94(17):743-755.
17. Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American heart association/American stroke association. Stroke. 2011;42(9):2672-2713.
18. Petersen RC, Smith GE, Ivnik RJ, et al. Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals. JAMA. 1995;273(16):1274-1278.
19. Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment—beyond controversies, towards a consensus: report of the international working group on mild cognitive impairment. J Intern Med. 2004;256(3):240-246.
20. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association; 1994.
21. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Publishing; 2013.
22. Harwood DG, Sultzer DL, Feil D, Monserratt L, Freedman E, Mandelkern MA. Frontal lobe hypometabolism and impaired insight in Alzheimer’s disease. Am J Geriatr Psychiatry. 2005;13(11):934-941.
23. Galton CJ, Patterson K, Xuereb JH, Hodges JR. Atypical and typical presentations of Alzheimer's disease: a clinical, neuropsychological, neuroimaging and pathological study of 13 cases. Brain. 2000;123(3):484-498.
24. Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. JAMA. 2014;312(23):2551-2561.
25. Lezak M, Howieson D, Loring D. Neuropsychological assessment. 4th ed. Oxford University Press; 2004.
26. Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: Administration, norms and commentary. 3rd ed. Oxford University Press; 2006.
27. Bradfield NI, Ellis KA, Savage G, et al. Aggregation of abnormal memory scores and risk of incident Alzheimer's disease dementia: a measure of objective memory impairment in amnestic mild cognitive impairment. J Int Neuropsychol Soc. 2021;27(2):146-157.
28. Bradfield NI, Ellis KA, Savage G, et al. Baseline amnestic severity predicts progression from amnestic mild cognitive impairment to Alzheimer disease dementia at 3 years. Alzheimer Dis Assoc Disord. 2018;32(3):190-196.
29. Mathuranath PS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR. A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology. 2000;55(11):1613-1620.
30. Velakoulis D, Walterfang M, Siu R. Validity and reliability of the NUCOG (neuropsychiatry unit cognitive screening tool). Aust N Z J Psychiatry. 2005;39:A132-A132.
31. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.
32. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699. doi.org/
33. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing. 1972;1(4):233-238.
34. Kertesz A. WAB-R: Western aphasia battery-revised. PsychCorp; 2007.
35. Mitrushina M, Boone KB, Razani J, D’Elia L. Handbook of Normative Data for Neuropsychological Assessment. 2nd ed. Oxford University Press; 2005.
36. Marcos A, Gil P, Barabash A, et al. Neuropsychological markers of progression from mild cognitive impairment to Alzheimer's disease. Am J Alzheimers Dis Other Demen. 2006;21(3):189-196.
37. Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69(18):1789-1799.
38. Taragano FE, Allegri RF, Lyketsos C. Mild behavioral impairment: a prodromal stage of dementia. Dement Neuropsychol. 2008;2:256-260.
39. Fischer P, Jungwirth S, Zehetmayer S, et al. Conversion from subtypes of mild cognitive impairment to Alzheimer dementia. Neurology. 2007;68(4):288-291.
40. Bermejo-Pareja F, Contador I, Trincado R, et al. Prognostic significance of mild cognitive impairment subtypes for dementia and mortality: data from the NEDICES cohort. J Alzheimers Dis. 2016;50(3):719-731.
41. Julayanont P, Brousseau M, Chertkow H, Phillips N, Nasreddine ZS. Montreal cognitive assessment memory index score (MoCA-MIS) as a predictor of conversion from mild cognitive impairment to Alzheimer's disease. J Am Geriatr Soc. 2014;62(4):679-684.
42. Summers MJ, Saunders NL. Neuropsychological measures predict decline to Alzheimer's dementia from mild cognitive impairment. Neuropsychology. 2012;26(4):498-508.
43. Damian M, Hausner L, Jekel K, et al. Single-domain amnestic mild cognitive impairment identified by cluster analysis predicts Alzheimer's disease in the European prospective DESCRIPA study. Dement Geriatr Cogn Disord. 2013;36(1):1-19.
44. Lee YM, Park JM, Lee BD, Moon E, Chung YI, Kang CJ. Memory impairment, in mild cognitive impairment without significant cerebrovascular disease, predicts progression to Alzheimer's disease. Dement Geriatr Cogn Disord. 2012;33(4):240-244.
45. Jungwirth S, Zehetmayer S, Hinterberger M, Tragl KH, Fischer P. The validity of amnestic MCI and non-amnestic MCI at age 75 in the prediction of Alzheimer's dementia and vascular dementia. Int Psychogeriatr. 2012;24(6):959-966.
46. Nordlund A, Rolstad S, Klang O, Edman A, Hansen S, Wallin A. Two-year outcome of MCI subtypes and aetiologies in the Goteborg MCI study. J Neurol Neurosurg Psychiatry. 2010;81(5):541-546.
47. Forlenza OV, Diniz BS, Nunes PV, Memoria CM, Yassuda MS, Gattaz WF. Diagnostic transitions in mild cognitive impairment subtypes. Int Psychogeriatr. 2009;21(6):1088-1095.
48. Yaffe K, Petersen RC, Lindquist K, Kramer J, Miller B. Subtype of mild cognitive impairment and progression to dementia and death. Dement Geriatr Cogn Disord. 2006;22(4):312-319.
49. Tabert MH, Manly JJ, Liu X, et al. Neuropsychological prediction of conversion to Alzheimer disease in patients with mild cognitive impairment. Arch Gen Psychiatry. 2006;63(8):916-924.
50. Ravaglia G, Forti P, Maioli F, et al. Conversion of mild cognitive impairment to dementia: predictive role of mild cognitive impairment subtypes and vascular risk factors. Dement Geriatr Cogn Disord. 2006;21(1):51-58.
51. Palmer K, Bäckman L, Winblad B, Fratiglioni L. Mild cognitive impairment in the general population: occurrence and progression to Alzheimer disease. Am J Geriatr Psychiatry. 2008;16(7):603-611.
52. Aarsland D, Bronnick K, Williams-Gray C, et al. Mild cognitive impairment in Parkinson’s disease: a multicenter pooled analysis. Neurology. 2010;75(12):1062-1069.
53. Breteler MM, van Swieten JC, Bots ML, et al. Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: the Rotterdam study. Neurology. 1994;44(7):1246-1252.
54. Dubois B, Feldman HH, Jacova C, et al. Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurol. 2010;9(11):1118-1127.
55. Wechsler D. Wechsler Adult Intelligence Scale. Fourth ed. Pearson; 2008.
56. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a frontal assessment battery at bedside. Neurology. 2000;55(11):1621-1626.
57. Wechsler D. Wechsler Memory Scale—(WMS-IV) Technical and Interpretive Manual. 4th ed. Pearson; 2009.
58. Ivnik RJ, Smith GE, Lucas JA, Tangalos EG, Kokmen E, Petersen RC. Free and cued selective reminding test: moans norms. J Clin Exp Neuropsychol. 1997;19(5):676-691.
59. Benedict RH, Schretlen D, Groninger L, Brandt J. Hopkins verbal learning test-revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12(1):43-55.
60. Kaplan EF, Goodglass H, Weintraub S. The Boston Naming Test 2nd ed. Lippincott Williams & Wilkins; 2001.
61. Benton AL, Hamsher K, Sivan AB. Multilingual Aphasia Examination. AJA Associates; 1994.
62. Rey A. L’examen psychologique dans les cas d’encephalopathie traumatique. Arch Psychol (Geneve). 1942;28:286-340.
63. Reitan RM, Wolfson D. The Halstead-Reitan Neuropsychological Test Battery. Neuropsychology Press; 1985.
64. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18(6):643-662.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: September 22, 2021
Issue published: January 2023
Keywords
PubMed: 34549629
Authors
Author Contributions
NB wrote the manuscript.
Metrics and citations
Metrics
Journals metrics
This article was published in Clinical EEG and Neuroscience.
VIEW ALL JOURNAL METRICSArticle usage*
Total views and downloads: 1103
*Article usage tracking started in December 2016
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 10 view articles Opens in new tab
Crossref: 5
- Eye movement changes as an indicator of mild cognitive impairment
- Combining reinforcement learning and virtual reality in mild neurocogn...
- Psychometric properties of the Cognitive Functioning Self-Assessment S...
- Special Issue: Mild Cognitive Impairment
- Association of Peripheral Blood Cell Profile With Alzheimer's Disease:...
Figures and tables
Figures & Media
Tables
View Options
Get access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
ECNS members can access this journal content using society membership credentials.
ECNS members can access this journal content using society membership credentials.
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
