Alzheimer's, Dementia & Mental Health
Large Numbers of Senior Citizens with Milder Alzheimer’s May See Diagnosis Change
New definition of ‘mild cognitive impairment’ changed; physicians may move AD patients back to MCI; seen more as
2012 - A large number of patients – mostly senior citizens – living with a diagnosis of very mild or even mild Alzheimer’s
disease may be reclassified as having mild cognitive impairment (MCI) due to a recent revision of the criteria for this condition, according
to a report published Online First by Archives of Neurology, one of the JAMA/Archives journals.
The revised criteria allow "considerable latitude" as to what represents functional independence, writes the study's sole
author, John C. Morris, M.D., of Washington University School of Medicine in St. Louis. For example, he says "mild problems" performing daily
activities such as shopping, paying bills and cooking are permissible, as is dependency on aids or assistance to complete those tasks.
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Alzheimer's, Dementia & Mental Health
The National Institute on Aging and the Alzheimer's Association convened a work group to update criteria for MCI.
In this study, the functional ratings of patients enrolled at federally funded Alzheimer's Disease Centers with clinical
and cognitive data maintained by the National Alzheimer's Coordinating Center were evaluated. A total of 17,535 people with normal cognition,
MCI or AD dementia met eligibility requirements. The mean (average) age of the total sample was 74.6 years.
The study suggests that 99.8 percent of patients currently diagnosed with very mild AD dementia and 92.7 percent of those
diagnosed with mild AD dementia could be reclassified as having MCI based on the revised criteria.
The difference between MCI and AD dementia in its earliest symptomatic stages has largely been based on whether cognitive
impairment disrupts the activities of daily living. The revised criteria "now obscure this distinction," Morris notes.
"The elimination of the functional boundary between MCI and AD dementia means that their distinction will be based solely
on the individual judgment of clinicians, resulting in nonstandard and ultimately arbitrary diagnostic approaches to MCI," Morris comments.
"This recalibration of MCI moves its focus away from the earliest stages of cognitive decline, confounds clinical trials
of individuals with MCI where progression to AD dementia is an outcome, and complicates diagnostic decisions and research comparisons with
The author suggests that the revised criteria for MCI "laudably recommend" an etiologic (origins) diagnosis, "MCI due to
AD," when the physician's judgment is that AD is responsible for an individual's cognitive dysfunction.
"The diagnostic overlap for MCI with milder cases of AD dementia is considerable and suggests that any distinction is
artificial and arbitrary," Morris concludes.
"Already, many individuals with MCI are treated with pharmacological agents approved for symptomatic AD, indicating that
clinicians often do not distinguish the two conditions when faced with issues of medical management. It now is time to advance AD patient care
and research by accepting that 'MCI due to AD' is more appropriately recognized as the earliest symptomatic stage of AD."
The research was supported by grants from the National Institute on Aging and the National Alzheimer's Coordinating
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