Subjective Memory Complaints
- Subjective complaints of memory problems have long been controversial as risk factors for the development of dementia. However, memory complaints are not highly correlated with actual memory deficits, but are more highly correlated with symptoms of depression or concerns about aging expressed by the so-called "worried well."
- Cacchione, et al. (2002) suggest that subjective memory reports are not always well correlated with current cognitive impairments. However, they did find that caregivers who live with patients provide descriptions of behaviors and cognitive abilities that accurately reflect patients' performances on memory and other cognitive tests.
- The Rotterdam Study Group (Geerlings, et al., 2002) suggests that memory complaints among persons without cognitive complaints are associated with neuroanatomical differences in hippocampal volume on MR. A growing body of evidence suggests that MR changes are associated with very early cognitive problems leading to question the possibility that some memory complaints may indeed predict future cognitive deterioration.
- The Sun Health Research Group (Connor, et al., 2002) found that part of the difficulty in evaluating the older patient's self-report of memory function is related to the way in which the question is asked. They found, in normal elderly persons, that the accuracy of self-reports of memory improved when the question was anchored to the patient's age group or contextualized in a time frame (e.g., ". . . compared to other people your age, and ". . . would you describe your memory as getting worse within the last couple of years?").
More Information: http://www.alz-nova.org
top
Mild Cognitive Impairment (MCI)
- Not a diagnostic entity at this time but is a descriptive term referring to a person who may be functioning quite well in daily life and does not meet clinical criteria for dementia. The individual complains of memory problems and shows evidence of mild impairments.
- Understanding MCI is seen as a potentially useful tool for identifying persons who are at very high risk for developing an Alzheimer's type dementia (AD) in the future.
- Molinenuevo et al. (2002) found that MCI patients with APOE e-4 all progressed more rapidly than those without this genetic risk factor.
- Duara et al. (2002) report longitudinal studies conducted to distinguish MCI/AD (amnestic) from MCI/non-AD. Differential rates of conversion to AD over two years are reported to be 51% and 23% respectively. Persons with mood disorders were more than twice as likely to convert to dementia during the subsequent two years than those who did not have mood disorders.
- The distinction between the non-AD and AD types of MCI has prognostic implications. Luis et al. (2002) examined neuropsychological predictors for the conversion of MCI to dementia in 71 patients with MCI/possible AD type and 74 patients with MCI/non-AD type. MCI/possible AD patients converted to dementia at a rate of three times that of the MCI/non-AD type patients.
- Risk factors for MCI amnestic type, reported by Lopez, et al. (2002), were presence of MRI infarcts and MRI ventricular size. For the multiple cognitive domain type (MCDT) of MCI, risk factors reportedly are race, lower levels of education, severity of white matter disease on MRI, and depression measures.
top
Dementia
- A syndrome that has multiple reversible and irreversible causes and requires systematic evaluation of the patient presenting with a cognitive impairment.
- In the USA, two definitions of dementia prevail:
- Dementia is an acquired, persistent decline involving at least three of the following five domains: language, memory, visuospatial skills, executive function, and personality and mood (Cummings, Benson, LoVerme, 1998). (Persistent decline must not be secondary to delirium.)
- Dementia requires impairment in short- and long-term memory with additional decline in at least one other domain that interferes with either occupational or social functioning or interpersonal relationships (APA, DSMIV, 1994).
Incidence of Dementia
Alzheimer's disease (AD) and vascular dementia (VaD) are the two leading causes of dementia in the elderly, with AD being the most common type. AD constitutes approximately 50% of all dementias in the elderly; 35% in younger individuals.
Major causes classified by dysfunction:
- Cortical:
- Alzheimer's disease
- Frontal lobe degeneration
- Subcortical:
- Extrapyramidal syndromes
- Lewy body disease
- Parkinson's disease
- Huntington's disease
- Progressive supranuclear palsy
- Wilson's disease
- Spinocerebellar degeneration
- Fahr's disease
- Normal Pressure Hydrocephalus
- Dementia of depression
- Demyelinating disease
- Vascular dementias
- Lacunar state
- Binswanger's disease
- Multi-infarct dementia
- Mixed (Vascular and Alzheimer's Disease)
- Infectious
- Syphilis
- Prion associated disorder (CJD)
- HIV encephalopathy
- Toxic/metabolic encephalopathies
- Endocrinopathies (hypothyroidism)
- Deficiency states
- Drug intoxications
- Heavy metal exposure (lead, aluminum)
- Industrial toxins
- Miscellaneous syndromes
- Posttraumatic
- Postanoxi
- Neoplastic
top
For research references: Resources | For more information: Useful Links
|
