Dementia and Neurocognitive Disorders (대한치매학회지)

Korean Dementia Association (대한치매학회)
권호 표지
DOI QR코드

DOI QR Code

Need for an Update for the Guideline for the Management of Mild Cognitive Impairment

  • Minji Kim (Department of Medicine, Ajou University School of Medicine) ;
  • So Young Moon (Department of Neurology, Ajou University School of Medicine)
  • Received : 2022.07.06
  • Accepted : 2022.09.13
  • Published : 2022.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Attention is being paid to diagnosis and treatment of mild cognitive impairment (MCI) because early diagnosis and preventive management can slow down the progression of Alzheimer's disease. In particular, in the present era, the use of biomarkers for predicting conversion into dementia is permitted in medical practice. Therefore, authors aimed to propose additional considerations when updating guidelines for the management of MCI, including predictable biomarkers, revising treatment option after additional clinical trials for cholinesterase inhibitors, and detailed regimes for lifestyle interventions. After reviewing 3 patients with MCI by detailed evaluation, we realized that cholinesterase inhibitors were not recommended. In addition, regular exercise and cognitive training were only possible recommendations for patients according to current guidelines, although all 3 patients had evidence of β-amyloid accumulation and related neurodegeneration. Furthermore, caregivers for all 3 patients were worried whether patients could keep doing regular exercise and cognitive training by themselves and asked about the economic training system which monitors patients so that they can keep training. Therefore, we propose that guidelines for managing MCI need to be updated in the present era when the use of biomarkers for predicting conversion into dementia is permitted in medical practice.

Keywords

Acknowledgement

This work was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) and Korea Dementia Research Center (KDRC), funded by the Ministry of Health & Welfare and Ministry of Science and ICT, Republic of Korea (HU21C0016).

References

  1. Jack CR Jr, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA-AA Research Framework: toward a biological definition of Alzheimer's disease. Alzheimers Dement 2018;14:535-562.
  2. Jack CR Jr, Knopman DS, Jagust WJ, Shaw LM, Aisen PS, Weiner MW, et al. Hypothetical model of dynamic biomarkers of the Alzheimer's pathological cascade. Lancet Neurol 2010;9:119-128.
  3. Matthews FE, Arthur A, Barnes LE, Bond J, Jagger C, Robinson L, et al. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 2013;382:1405-1412.
  4. Wu YT, Fratiglioni L, Matthews FE, Lobo A, Breteler MM, Skoog I, et al. Dementia in western Europe: epidemiological evidence and implications for policy making. Lancet Neurol 2016;15:116-124.
  5. Petersen RC, Lopez O, Armstrong MJ, Getchius TS, Ganguli M, Gloss D, et al. Practice guideline update summary: mild cognitive impairment: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2018;90:126-135.
  6. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.
  7. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, 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. Alzheimers Dement 2011;7:270-279.
  8. Jack CR Jr, Albert MS, Knopman DS, McKhann GM, Sperling RA, Carrillo MC, et al. Introduction to the recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011;7:257-262.
  9. Petersen RC, Lopez O, Armstrong MJ, Getchius TS, Ganguli M, Gloss D, et al. Practice guideline update summary: mild cognitive impairment: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2018;90:126-135.
  10. Lee JS, Kim GH, Kim HJ, Kim HJ, Na S, Park KH, et al. Clinical practice guideline for dementia (diagnosis and evaluation): 2021 revised edition. Dement Neurocogn Disord 2022;21:42-44.
  11. Scheltens P, Leys D, Barkhof F, Huglo D, Weinstein HC, Vermersch P, et al. Atrophy of medial temporal lobes on MRI in "probable" Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates. J Neurol Neurosurg Psychiatry 1992;55:967-972.
  12. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149:351-356.
  13. Park SA, Jang YJ, Kim MK, Lee SM, Moon SY. Promising blood biomarkers for clinical use in Alzheimer's disease: a focused update. J Clin Neurol 2022;18:401-409.
  14. Kang SJ, Choi SH, Lee BH, Kwon JC, Na DL, Han SH, et al. The reliability and validity of the Korean activities of daily living (K-IADL). J Korean Neurol Assoc 2002;20:8-14. 
  15. Kasper S, Bancher C, Eckert A, Forstl H, Frolich L, Hort J, et al. Management of mild cognitive impairment (MCI): the need for national and international guidelines. World J Biol Psychiatry 2020;21:579-594.
  16. Galluzzi S, Geroldi C, Amicucci G, Bocchio-Chiavetto L, Bonetti M, Bonvicini C, et al. Supporting evidence for using biomarkers in the diagnosis of MCI due to AD. J Neurol 2013;260:640-650.
  17. Sano M. ICAD 2010: Detection may hold the key to treatment. International Conference on Alzheimer Disease (ICAD) 2010 Honolulu, HI, USA, 10-15 July 2010. Expert Rev Neurother 2010;10:1659-1661.
  18. Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005;352:2379-2388.
  19. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-1142.
  20. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al. Current concepts in mild cognitive impairment. Arch Neurol 2001;58:1985-1992.
  21. Lopez OL, Jagust WJ, DeKosky ST, Becker JT, Fitzpatrick A, Dulberg C, et al. Prevalence and classification of mild cognitive impairment in the Cardiovascular Health Study Cognition Study: part 1. Arch Neurol 2003;60:1385-1389.
  22. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183-194.
  23. Ganguli M, Dodge HH, Shen C, DeKosky ST. Mild cognitive impairment, amnestic type: an epidemiologic study. Neurology 2004;63:115-121.
  24. Edmonds EC, Ard MC, Edland SD, Galasko DR, Salmon DP, Bondi MW. Unmasking the benefits of donepezil via psychometrically precise identification of mild cognitive impairment: a secondary analysis of the ADCS vitamin E and donepezil in MCI study. Alzheimers Dement (N Y) 2017;4:11-18.
  25. Edmonds EC, Delano-Wood L, Clark LR, Jak AJ, Nation DA, McDonald CR, et al. Susceptibility of the conventional criteria for mild cognitive impairment to false-positive diagnostic errors. Alzheimers Dement 2015;11:415-424.
  26. Bangen KJ, Clark AL, Werhane M, Edmonds EC, Nation DA, Evangelista N, et al. Cortical amyloid burden differences across empirically-derived mild cognitive impairment subtypes and interaction with APOE varepsilon4 genotype. J Alzheimers Dis 2016;52:849-861.
  27. Edmonds EC, Eppig J, Bondi MW, Leyden KM, Goodwin B, Delano-Wood L, et al. Heterogeneous cortical atrophy patterns in MCI not captured by conventional diagnostic criteria. Neurology 2016;87:2108-2116.
  28. Kivipelto M, Mangialasche F, Snyder HM, Allegri R, Andrieu S, Arai H, et al. World-Wide FINGERS Network: a global approach to risk reduction and prevention of dementia. Alzheimers Dement 2020;16:1078-1094.
  29. Moon SY, Hong CH, Jeong JH, Park YK, Na HR, Song HS, et al. Facility-based and home-based multidomain interventions including cognitive training, exercise, diet, vascular risk management, and motivation for older adults: a randomized controlled feasibility trial. Aging (Albany NY) 2021;13:15898-15916.