Mild Cognitive Impairment (MCI) is the diagnosis used for older individuals with proven memory and other cognitive problems such as language, orientation, verbal fluency and  which do not meet the level of diagnosis for dementia.  Most or all Alzheimer and other dementia patients pass through this phase, although not all MCI patients progress to dementia.  More research is being done in this area, since treatments for dementia have not been very successful.

44% MCI Progressed to AD in 6 Years: In a study of 181 older Catholic clergy members who met criteria for MCI from the Religious Orders Study, 31% had at least one epsilon4 allele. During 5.7 years of follow-up, 44% developed AD. After controlling for age, education, and sex, possession of an epsilon4 allele was associated with a 93% increase in the risk of developing Alzheimer's disease. The apolipoprotein E epsilon4 allele and incident Alzheimer's disease in persons with mild cognitive impairment. Aggarwal NT, et al. Rush University, Chicago. Neurocase. 2005 Feb;11(1):3-7

64% MCI Progressed in 2 Years: In a study of 56 patients referred to two teaching hospitals who had at least a 3-month history of memory problemsconversion rates to AD were 41% after 1 year, and 64% after 2 years. Mild cognitive impairment: an operational definition and its conversion rate to Alzheimer's disease. Geslani DM et al. Toronto, Canada. Dement Geriatr Cogn Disord. 2005;19(5-6):383-9. Ed: These were probably a more impaired sample than the clergy study since they were severe enough to be referred to a specialty clinic.

MCI Reversible in 20% of MCI Stroke Victims: In a study of 118 patients with a first ever cerebral stroke followed up for 2 years, 20% patients recovered from their MCI. Most of these occurred early in the recovery period. Higher baseline MMSE scores and female sex were independent predictors of recovery (OR(High MMSE)=9.9; OR(female sex)=2.8). Neither stroke-related risk factors nor CT variables were predictors of favorable outcome. Predictors of reversible mild cognitive impairment after stroke: a 2-year follow-up study. Rasquin SM et al. University of Maastricht, The Netherlands. J Neurol Sci. 2005 Mar 15;229-230:103-7

MCI Progression Detailed: In a 6-year follow-up study of 3734 Japanese-American men ages 71-93 at baseline, 52 developed dementia. These had shown deficits 3 to 6 years earlier in episodic memory and subjective memory problems. Up to 3 years before onset, there was worsening of the episodic memory deficit from baseline and new deficits in language, verbal fluency, and orientation. Cognitive deficits 3 to 6 years before dementia onset in a population sample: the Honolulu-Asia aging study. Jorm AF, et al. Australian National University, Canberra, Australia. J Am Geriatr Soc. 2005 Mar;53(3):452-5

Vitamin E, Donepezil (Aricept) Fail to Help Mild Cognitive Impairment: In a 3-year DB PC study of 769 patients with mild cognitive impairment, vitamin E had no effect on 769 patients with mild cognitive impairment. The expensive anti-dementia drug donepezil (Aricept) showed no slowing of the rate of progression of the disease after three years compared with placebo, although it had a limited benefit during the first year. Donepezil will no longer be prescribed by the National Health Service in England for new dementia patients. The overall rate of progression from mild cognitive impairment to early Alzheimer▓s disease was 16% a year. Probability of progression for vitamin E was increased by 2% and for donepezil decreased by 20%, both of which were far from significant. Petersen RE, et al. N Engl J Med. 2005 Jun 9;352(23):2379-88

Donepezil (Aricept) Not Cost-Effective for Mild Cognitive Impairment; Only Mild Benefit: In a 24-week, 270-patient DB PC study of mild cognitive impairment (MCI), those receiving donepezil ( 5 mg/day for 42 days, then 10 mg/day) or placebo (n = 137) did not show benefit on the primary efficacy measures of the NYU Paragraph Recall test and the ADCS CGIC-MCI. More did show improvements in ADAS-cog total scores, in tests of attention and psychomotor speed, and in PGA scores. Efficacy of donepezil in mild cognitive impairment: a randomized placebo-controlled trial. Salloway S, Ferris S, Kluger A, Goldman R, Griesing T, Kumar D, Richardson S; Donepezil 401 Study Group. Brown University. Neurology. 2004 Aug 24;63(4):651-7. Ed: At the high cost of donepezil, the small amount of improvement is just not worth the public's money.

Rofecoxib No Benefit in Mild Cognitive Impairment: In a 4-year DB PC study of 1457 patients with mild cognitive impairment (MCI), those on rofecoxib 25 mg daily had an annual AD diagnosis rate of 6.4% vs 4.5% in the placebo group (rofecoxib : placebo hazard ratio=1.46, p=0.011). There was no consistant evidence that rofecoxib was helpful on any of the testing measures. A randomized, double-blind, study of rofecoxib in patients with mild cognitive impairment. Thal LJ et al. University of California, San Diego. Neuropsychopharmacology. 2005 Jun;30(6):1204-15

Thomas E. Radecki, M.D., J.D.

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