Mild Cognitive Impairment Introduction

With the graying of America, the classification of memory difficulties has received increased attention. Commonly, clinicians encounter patients with memory and other cognitive problems, ranging from abundant memory slips to various other difficulties with routine living skills, but who do not meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for dementia. On formal neu-ropsychological evaluations they show mild deviations from normal capacities but do not show the striking memory deficits or problem-solving difficulties associated with AD and other forms of dementia.

However, it is critical to know when an abundance of such "senior moments" begins to reflect the development of a progressive neurodegenerative illness. The growing need to address such issues has led to the development of additional categories to classify cognitive impairments that do not meet diagnostic criteria for dementia.

Various terms have been suggested to describe these conditions, including age-associated memory impairment (AAMI), age-associated cognitive decline (AACD), and mild cognitive impairment (MCI). The first two terms imply that the cognitive changes are associated with aging per se rather than any disease process. Thus, they might lead clinicians and investigators away from other causes of cognitive impairment or decline. In addition, AAMI focuses exclusively on memory rather than cognition in general. As such, AAMI and AACD came under criticism, and MCI became the preferred term to describe persons who manifest changes in cognition and functioning that place them between normal individuals and those suffering from mild dementia (Petersen et al., 2001). Because MCI is believed to be a significant risk factor for the eventual development of dementia, and especially AD, the early identification of this syndrome as an entity separate from normal aging may be important for early intervention. Presently, its identification may also assist patients and their families with planning end-of-life issues. In the following section, definitions of MCI will be discussed, and the relationship of MCI to dementia and other conditions associated with aging will be reviewed.

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