6/6/2019 1 v.s. Asst. Prof. Chatchawan Rattanabannakit, MD. Division of Neurology, Department of Medicine Faculty of Medicine Siriraj Hospital, Mahidol University Dementia Association of Thailand Annual Conference June 6 th -7 th , 2019 Definition and Diagnosis: MCI vs SCD 2 CLINICAL SPECTRUM IN ALZHEIMER’S DISEASE Preclinical MCI Dementia Adapted from: Jack Jr CR, et al. Brain. 2010;133:3336–48. Aβ Tau Brain structure Cognition Clinical function Decades 3 EVOLUTION OF THE MCI CRITERIA Petersen RC. Continuum (Minneap Minn) 2016; 22(2): 404-18 4 CRITERIA FOR AMNESTIC MCI 5 6
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6/6/2019
1
v.s.
Asst. Prof. Chatchawan Rattanabannakit, MD.Division of Neurology, Department of Medicine
Faculty of Medicine Siriraj Hospital, Mahidol University
Dementia Association of Thailand Annual Conference
June 6th -7th, 2019
Definition and
Diagnosis: MCI vs SCD
2
CLINICAL SPECTRUM IN ALZHEIMER’S DISEASE
Preclinical MCI Dementia
Adapted from: Jack Jr CR, et al. Brain. 2010;133:3336–48.
Adapted from: Jessen F, et al. Alzheimers Dement. 2014
Preclinical AD MCI/prodromal AD Dementia
Onset of decline
in cognitive performance
Impairment on a
cognitive test
Age-, sex- and education adjusted
normal performance range
Co
gn
itiv
e p
erf
orm
an
ce
Progression of disease pathology and clinical states
Subjective cognitive decline (SCD)(Indicating compensation and subtle decline in cognitive performance)
Concept of Subjective Cognitive Decline (SCD) in
preclinical AD
13
Research criteria for pre-MCI subjective cognitive
decline (SCD)
1 and 2 must be present
1. Self-experienced persistent decline in cognitive capacity in comparison with a previously normal status and unrelated to an acute event.
2. Normal age-, gender-, and education-adjusted performance on standardized cognitive tests, which are used to classify mild cognitive impairment (MCI) or prodromal AD.
Exclusion criteria
Mild cognitive impairment, prodromal AD, or dementia
Can be explained by a psychiatric* or neurologic disease (apart from AD), medical disorder, medication, or substance use
Jessen F, et al. Alzheimers Dement. 2014
*Individual symptoms of depression or anxiety, which do not reach
the threshold of a disorder, are not considered exclusion criteria
14
COGNITIVE COMPLAINT ASSESSMENT
Clinical interview: Subjectively
YES/NO Question
Graded response question
Validated tests such as MAC-Q, Ecog, AD8, CCI etc.
Whom should be evaluated?
Patient**
Knowledgeable informant
Both 15
Self-report VS Informants-report
The report of an individual’s cognitive decline by informants was
better correlated with objective cognitive test performance than the
report by the subject themselves and may be a better predictor of
subsequent MCI or dementia1-5.
Moreover, as compared to informant-only or self-only report of
cognitive decline, using the mutual report by both subjects and
informants was found to be a better prediction of diagnostic
outcome and associated with the worst cognitive trajectory6-7.
1. Gavett R, et al. Alz Dis Assoc Dis. 2011
2. Rami L, et al. J Alzheimers Dis. 2014
3. Slavin MJ, et al. Am J Geriat Psychiat. 2014
4. Rabin LA, et al. J Am Geriatr Soc. 2012
5. Caselli RJ, et al. Alzheimers Dement. 2014
6. Gifford KA, et al. Alzheimers Dement. 2013
7. Gifford KA, et al. J Alzheimer Dis. 2015 16
17
Other consideration in diagnosis of SCD
It is acknowledged that depression, anxiety and personality may
affect the perception of cognitive decline as well as the objective
cognitive performance1.
In populations with chronic health difficulties, cognitive
complaints may be more highly associated with physical health
symptoms than with objective impairment2.
Linguistic and cultural factors may also influence the report of
cognitive complaints3-4.
181. Jessen F, et al. Alzheimers Dement. 2014
2. Boone KB, et al. Clin Neuropsychol. 2009
3. Jackson JD, et al. Alzheimers Dement. 2016
4. Rabin LA, et al. Annu Rev Clin Psychol. 2017
6/6/2019
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Diagnosis of Cognitive Impairment
Subjective
Cognitive
Complaints
Objective
Cognitive
Impairment
Functional
Impairment
Biomarkers / Genetics
Subjective Cognitive Decline (SCD)
Functional Impairment(Activities of daily livings: ADL)
Subjective
Cognitive
Complaints
Objective
Cognitive
Impairment
Functional
Impairment
Biomarkers / Genetics
Functional Impairment(Activities of daily livings: ADL)
Mild Cognitive Impairment (MCI)
PREVALENCE
AND THE RISK OF
FUTURE DEMENTIA20
PREVALENCE OF MCI
Overall prevalence of MCI is in the 12 - 18% range in
persons over the age of 60 years.
The Mayo Clinic Study of Aging followed cognitively normal
subjects 70 years and older for a median of 5 years and
found the progression rate to be MCI is in the 5 - 6% per
Golomb J, et al. Dialogues Clin Neurosci. 2004; 6: 351-6723
PROGNOSIS OF MCI
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10 -15% (5-17) per year
Rates of conversion also vary according to the duration of follow-up; one analysis compared longer duration (>5 years) to shorter duration studies and found lower rates with longer durations of follow-up
The risk of conversion decreases over time
Typically, patients convert within a period of two to three years;however, longer intervals of up to eight years have been reported