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PubMedDate not supplied

ICD-10 mild cognitive disorder following meningitis due to neurosarcoidosis.

We report the case of a patient referred to our department with the diagnosis of conversion disorder, who ultimately proved to have neurosarcoidosis presenting with mild cognitive disorder. Despite the criticism of mild cognitive disorder as a diagnostic entity, our patient met the criteria for it. The reported case exemplifies the difficulties in classifying mild cognitive deficits in patients suffering from brain diseases without major morphological damage.

Adult↗
PubMed2000

Comorbidity of mild cognitive disorder and depression--a neuropsychological analysis.

Mild cognitive impairment is found in many cases of depression, and it is mostly assumed to improve during the time course of depression remission. Recent data question the reversibility of low cognitive test performance in depression. The aim of this study is to determine the degree of reversibility and the proportion of patients who will not demonstrate reversibility of cognitive dysfunction. Consecutive inpatients suffering from depression (N=102) were investigated and N=82 matched control subjects. N=57 of the patients were diagnosed as major depression according to DSM-IV. A total of N=67 could be retested after remission of depression (N=32 of the patients with major depression) and a matched control group (N=62). Neuropsychological tests were applied in a test session which avoids the effects of fatigue in the patients by the short duration of strenuous tests. For most neuropsychological tests an impaired performance in the depressed patients was found. About one third of the depression subjects performed at an impaired level in tests of averbal memory and verbal fluency (below 5th percentile). In the follow-up investigation, a slight improvement in performance could be assessed for both the depression and the control group, which was, however, attributed to a general test training effect. No normalization of cognitive test performance was found in spite of complete recovery of the affective symptoms. No correlation between the duration of the disease before the index episode or number of episodes and cognitive deficits could be found. The data of the neuropsychological deficits of depressed patients, which are stable in the time course of the affective disorder, may indicate that these patients may suffer from comorbidity of both depression and mild cognitive disorder. The findings are discussed as 1) indicating only a minor impact of the depressed mood on the cognitive performance and 2) they are consistent with a role of brain lesions which have been reported in several studies in a subgroup of depression.

Cognition Disorders↗
PubMed1997

ICD-10 mild cognitive disorder: its outcome three years later.

OBJECTIVE: The aims were to (i) report the outcome of mild cognitive disorder (MCD) 3.6 years after initial interview and diagnosis; (ii) identify predictors of new cases of MCD. The hypotheses were that (i) persons with MCD are more likely to develop dementia than those without MCD; (ii) symptoms of anxiety or depression predict MCD caseness at follow-up. DESIGN: Longitudinal cohort study. SETTING: Community of elderly people (age 70-97 years). PARTICIPANTS: 612 of 897 elderly subjects (mean 76 years) were reinterviewed. Of the 36 MCD cases originally identified, 25 were available at follow-up. 24 incident cases of MCD were identified. MAIN OUTCOME MEASURES: ICD-10 dementia, DSM-III-R dementia, ICD-10 mild cognitive disorder diagnoses made by the Canberra Interview for the Elderly, tests of anxiety, depression, neuroticism and cognitive performance. MAIN RESULTS: Of the original 25 MCD cases available at follow-up, two had a diagnosis of MCD, and three had a diagnosis of both ICD-10 and DSM-III-R dementia. The prevalence of MCD and DSM-III-R dementia at follow-up was no greater for MCD cases diagnosed at initial interview than in normal subjects at initial interview. There was, however, an increased prevalence of ICD-10 dementia among original MCD cases. At initial interview and at follow-up MCD cases were more anxious and depressed but had similar cognitive performance to normals. For incident cases of MCD the only significant predictor was age. CONCLUSIONS: MCD cannot be seen to be a specific forerunner of dementia. Those with a diagnosis of MCD are distinguished more by their anxiety, depression and neuroticism than by their cognitive deficits.

Aged↗
PubMed1995

ICD-10 mild cognitive disorder: epidemiological evidence on its validity.

Criteria for the diagnosis of ICD-10 Mild Cognitive Disorder (MCD) were applied to a sample of 897 community dwelling elderly participants. Criterion A (the presence of a physical disorder) was met by 44%, Criterion B (report of a cognitive disorder) by 17%, Criterion C (an abnormality in quantified cognitive assessments) by 60%, and Criterion D (exclusion on basis of dementia and other conditions) by 74%. A total of 36 cases (4%) met all four criteria. Correlations between Criteria A and B, and B and C were weak (r = 0.18), and the correlation between Criteria A and C was almost zero (r = 0.02). This suggests that no syndrome exists. Membership of MCD was predicted by a report that memory or intelligence interfered with daily life but not by performance on cognitive tests or by a report of physical illness. Cases of MCD had higher anxiety, depression and neuroticism scores than normal elderly, but did not differ substantially on tests of cognitive functioning. These findings call into question the validity of the ICD-10 diagnosis of MCD.

Activities of Daily Living↗
PubMed2004

[Mild cognitive disorder. Questions of definition, diagnosis, prognosis and therapy].

The syndrome of mild cognitive impairment (MCI) is heterogeneous in terms of aetiology, psychopathology, and prognosis. It is characterised by cognitive deterioration significantly exceeding the decline attributable to aging but not reaching the severity of dementia. The prevalence of MCI is estimated to be 17% in the population over 65 years old. At neuropathological examination, a large proportion of patients with mild cognitive impairment, particularly of the amnestic type, show typical features of Alzheimer's disease. The former progresses to dementia at an annual rate of 10% to 15%. In some cases, however, there is stable impairment or remission. The neurodegenerative process of Alzheimer's disease can be demonstrated in at least some patients using volumetric magnetic resonance imaging, 18-FDG positron emission tomography, or biochemical markers in the cerebrospinal fluid. It is not yet known whether patients with mild cognitive impairment or at least those with predementia Alzheimer's disease can benefit from currently available symptomatic treatments. Patients with early-stage Alzheimer's are an important target group for treatment interventions aiming at slowing the neurodegenerative process.

Adult↗
PubMed2002

[Socioeconomic significance of dementia and mild cognitive disorders].

While diagnostic criteria and epidemiologic results are available for dementia, reliable quantitative information on mild cognitive impairment is rare. The distinction between mild cognitive impairment, effects of normal ageing and dementia can be difficult to establish. Conceptual problems notwithstanding, a growing number of patients with dementia and with mild cognitive impairment can be safely predicted. Reduced quality of life on the part of patients and their families, growing demand for care and increasing costs of illness will prove the socioeconomic relevance of dementia.

Aged↗
PubMedDate not supplied

Prediction of deterioration in mild cognitive disorder in old age--neuropsychological and neurochemical parameters of dementia diseases.

In normal senescence, an age-related impairment of cognitive function is observed. The difficult clinical question is in which cases of mild cognitive impairment (MCI) will there be a rapid cognitive decline to a dementia syndrome. Two ways to improve prognosis are discussed: neuropsychological tests and analysis of neurochemical markers. First, the question is asked as to whether there are clusters of MCI. Longitudinal neuropsychological data from the Berlin Aging Study (BASE) are presented, a population-based sample of 516 subjects aged 70 to 103 years. There are clusters found that in part match those clusters, which have been identified by a study from Ritchie et al. in 1996. Especially, a cluster of 13.8% of the nondemented participants with a decline in memory performance is observed. The validation of clusters of cognitive performance and decline opens up the possibility of diagnosing distinctive subgroups of MCI to improve prognosis in old age. Second, the existing data concerning the diagnostic laboratory analysis for Alzheimer's disease (AD) are reviewed. Especially, data regarding nerve growth factor (NGF) are reported. In MCI, preliminary data show a correlation between the NGF serum level and cognitive performance. It can be concluded that the combined investigation of neuropsychological functions and cognitive decline, as well as laboratory measurement of neurochemical markers, might allow an improved prognosis for mental health in very old age.

Aged↗
PubMed2006

Conversion to dementia from mild cognitive disorder: the Cache County Study.

OBJECTIVE: To examine 3-year rates of conversion to dementia, and risk factors for such conversion, in a population-based sample with diverse types of cognitive impairment. METHODS: All elderly (aged 65 or older) residents of Cache County, UT, were invited to undergo two waves of dementia screening and assessment. Three-year follow-up data were available for 120 participants who had some form of mild cognitive impairment at baseline. Of these, 51 had been classified at baseline with prodromal Alzheimer disease (proAD), and 69 with other cognitive syndromes (CS). RESULTS: Three-year rates of conversion to dementia were 46% among those with cognitive impairment at baseline. By comparison, 3.3% without impairment converted to dementia in the interval. Among converters, AD was the most common type of dementia. In individuals with at least one APOE epsilon4 allele, those with proAD or CS exhibited a 22- to 25-fold higher risk of dementia than cognitively unimpaired individuals (vs 5- to 10-fold higher risk in those without epsilon4). CONCLUSIONS: Individuals with all types of mild cognitive impairment have an elevated risk of dementia over 3 years, more so in those with an APOE epsilon4 allele. These results suggest value in dementia surveillance for broad groups of cognitively impaired individuals beyond any specific category, and utility of APOE genotyping as a prognostic method.

Aged↗
PubMed2006

Level of cognitive impairment predicts mortality in high-risk community samples: the memory and medical care study.

Over the course of 3 years, the authors investigated the relationship between severity of cognitive impairment and mortality in a community sample of 498 elders at high risk for cognitive impairment. Subjects were classified as having no cognitive disorder, mild cognitive impairment, or dementia, based on a validated battery of four neuropsychological tests. Severity of impairment was based on Mini-Mental State Examination scores. Additional data were obtained from subjects' knowledgeable informants and Medicare records. Kaplan-Meier survival estimates and Cox hazard proportion analysis of the sample revealed that presence of cognitive impairment increases mortality in a fashion that parallels the severity of the impairment.

Aged↗
PubMedDate not supplied

[Descriptive study of behavioural disorders in mild cognitive impairment].

INTRODUCTION: Mild cognitive impairment (MCI) is defined as an abnormality in cognitive function not provoking a noticeable disability in activities of daily living in the affected person. In a group of patients with MCI, we propose to observe and to quantify the presence of behavioral disorders, using the neuropsychiatric inventory (NPI). PATIENTS AND METHODS: NPI is a known instrument in evaluation of this kind of disorders in patients with dementia, and it is a semi structured interview with a relevant informer or relative to the patient. NPI was applied to a series of 100 cases (61 women and 39 men) of MCI, diagnosed as usual in our settings. Mean age was 74.3 +/- 10 years, and mean MEC (Spanish modified version of MMSE) 25.57 +/- 4.2 (over a maximum of 35 points). RESULTS: Most prevalent disorder was depression, in 36 % of cases, and other frequent findings were irritability (35%), anxiety (24%) and apathy (19%). In some cases, agitation (4%), abnormal motor behavior (3%) and delusions (1%) were detected. Hallucination, disinhibition and euphoria or elation were not detected in this series. CONCLUSION: Data show a certain similarity with occidental culture environment, globally considered. The presence of behavioral and psychological disorders in patients with MCI could be a marker for later development of dementia. NPI can be a usable tool when detection and evaluation of these symptoms is required.

Aged↗
PubMed2000

[Effectiveness of felodipine in hypertensive patients with mild cerebral cognition disorders in a randomized double-blind study].

BACKGROUND AND OBJECTIVE: Cognitive impairment occurs more frequently in hypertensives than in normotensive individuals. Early signs of cognitive impairment are predictors of dementia in late life. Felodipine is capable of almost normalizing plasma viscosity, which is elevated in most of hypertensive patients, thus improving microcirculation. The aim of this study was to evaluate whether this hemorheologic property of felodipine in addition to its blood pressure lowering effect can improve cognitive performance in hypertensive patients. PATIENTS AND METHODS: Randomized, double-blind comparison between felodipine 10 mg and hydrochlorothiazide 50 mg amiloride 5 mg (HCT/amiloride) in patients 50-70 years of age with impaired cognitive function (c.l. test 1-2 points) and with resting blood pressure values of diastolic > 95 and < or = 115 mmHg and/or systolic > 160 and < or = 210 mmHg. Blood pressure measurements and evaluation of total short term storage capacity were done at the beginning and after 12 weeks of treatment. RESULTS: 31 patients (14 felodipine and 17 HCT/amiloride) were included in the per protocol analysis. Blood pressure values at the beginning and after 12 weeks of treatment were (mmHg): for felodipine systolic 168 +/- 4 and 150 +/- 6 (p < 0.01), diastolic 108 +/- 3 and 88 +/- 4 (p < 0.001). For amiloride/HCT systolic 173 +/- 8 and 150 +/- 10 (p < 0.01), diastolic 105 +/- 5 and 88 +/- 5 (p < 0.001). Short term storage capacity improved by 15 +/- 6 bits during felodipine treatment (p < 0.001) and by 9 +/- 9 bits during amiloride/HCT treatment (p < 0.05). Thus cognitive improvement was superior by 67% in the felodipine group compared to amiloride/HCT (p < 0.05). CONCLUSION: In this study a pronounced improvement of mental performance occurred in patients treated with felodipine. Since the cognitive gain was significantly superior to amiloride/HCT treatment there must be an additional blood pressure-independent effect of felodipine, such as enhancing microcirculation. Whether these properties possibly counteract the development of dementia in hypertensives has to be evaluated in long term studies in more patients.

Aged↗
PubMed2002

[Mild cognitive decline in the elderly: nosology and clinical status].

Cognitive impairment without dementia is common in elderly persons and causes significant impairment in capacity to perform everyday activities. A number of nosological entities have been proposed for the classification of sub-clinical cognitive dysfunction. The more recent concepts assume an underlying organic condition, in particular the presence of early stage dementia. While prospective studies suggest that persons with mild cognitive disorder have a high risk of developing dementia, long-term follow-up of subjects with mild cognitive impairment suggests that dementia alone does not explain all cases. Cognitive disorder in the elderly must be construed as a common outcome for a number of interacting pathologies whose expression is also mediated by genetic, environmental and social factors.

Aged↗
PubMed1997

Do cognitive complaints either predict future cognitive decline or reflect past cognitive decline? A longitudinal study of an elderly community sample.

Data from a two-wave longitudinal study of an elderly community sample were used to assess whether cognitive complaints either predict subsequent cognitive decline or reflect past cognitive decline. Cognitive complaints and cognitive functioning were assessed on two occasions three and a half years apart. Cognitive complaints at Wave 1 were found not to predict future cognitive change on the Mini-Mental State Examination, an episodic memory test or a test of mental speed. Similarly, cognitive complaints at Wave 2 were unrelated to past cognitive changes on these tests after statistically controlling for the effects of anxiety and depression. Furthermore, cognitive complaints did not predict either mortality (after controlling for anxiety and depression) or future dementia. These results are evidence against the inclusion of cognitive complaints in diagnostic criteria for proposed disorders such as age-associated memory impairment, mild cognitive disorder and ageing-associated cognitive decline.

Aged↗
PubMed2002

Social factors and psychopathology in epilepsy.

One hundred and six epilepsy patients were assessed over a period of 6 months for psychiatric morbidity, social support, stressful life events in previous year and disability. 45 patients (42.45%) had a psychiatric diagnosis. Organic depressive disorder headed the list (16.98%) followed by mild cognitive disorder (11.32%) and tobacco dependence (8.49%). There was no significant difference in the mean age, sex, mean education, age at onset of epilepsy, duration of epilepsy, psychiatric diagnosis, mean scores on social support scale, presumptive stressful life event scale and disability assessment schedule between different types of epilepsy. The difference in mean scores of presumptive stressful life events scale and disability assessment schedule between epileptics with and without psychiatric diagnosis was not statistically significant.

Adult↗
PubMed2002

[Mental disorders in the course of lyme borreliosis and tick borne encephalitis].

BACKGROUND: Lyme borreliosis is a chronic, multisystem disease, of prolong course with three consecutive stages, caused by a tick-transmitted spirochete Borrelia burgdorferi. Tick Borne Encephalitis (TBE) is neuroinfection caused by Tick Borne Encephalitis Virus (TBEV). OBJECTIVE: We evaluated the occurrence of psychiatric manifestations in the early phase of borreliosis-erythema migrans and neuroboreliosis as well as in its late phase--in arthritis and in the Tick-Born Encephalitis. The aim of the study was to single out the most frequent psychiatric symptoms and psychopathological syndroms and to determine their dynamics. METHODS: The study was carried out between 1999 and 2000 and comprised 174 patients of the Department of Psychiatry and Department of Infectious and Neuroinfectious Diseases of Medical Academy in Bialystok. Seventy seven patients diagnosed with arthritis, 20 with neuroborreliosis, 26 with skin manifestation-erythrema migrans and 51 with KZM participated. All subjects underwent psychiatric evaluation twice--during hospitalization and six month after discharge. Mental status examinations included general psychiatric examination and battery of scales and tests: Mini Mental State Examination, Beck Depression Inventory, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Reitan's Trail Making Test, Choynowsky Memory Scale, Symptoms Inventory and neuropsychological testing. RESULTS: Both in the course of TBE and Lyme borreliosis the majority of patients experienced psychiatric problems in the acute phase of disease as well as in the late phase--3, 6 months after the onset of the disease. The most common psychiatric manifestations were depressive disorders--episodes of depression or organic mood disorders, and cognitive deficits which manifest themselves as mild cognitive disorder or dementia. CONCLUSION: Psychiatric assessment is important in early stage of kzm and borreliosis but first of all after termination of acute symptomatology.

Borrelia burgdorferi↗