Mild cognitive impairment: diagnosis, longitudinal course, and emerging treatments

Abstract

Mild cognitive impairment (MCI) is widely regarded as the intermediate stage of cognitive impairment between the changes seen in normal cognitive aging and those associated with dementia. Elderly patients with MCI constitute a high-risk population for developing dementia, in particular Alzheimer's disease (AD). Although the core clinical criteria for MCI have remained largely unchanged, the operational definition of MCI has undergone several revisions over the course of the last decade and remains an evolving diagnosis. Prognostic implications of this diagnosis are becoming clearer with regard to the risk of progressive cognitive deterioration. Although patients with MCI may represent an optimal target population for pharmacological and non-pharmacological interventions, results from clinical trials have been mixed and an effective treatment remains elusive. This article provides a brief overview of the evolution of the concept of MCI and reviews current diagnostic criteria, the longitudinal course of the disorder, and current and emerging treatments for MCI.

Figure 1

Comparison of current diagnostic criteria for mild cognitive impairment (MCI). Common core characteristics shared by each diagnostic system are indicated in the center triangle. Criteria included are as follows: Revised Mayo Clinic Criteria [2,3], the National Institute on Aging-Alzheimer’s Association workgroup (NIA-AA) criteria for MCI due to Alzheimer’s disease (AD) [8], and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) [9].