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Can treatment prevent dementia in people with mild cognitive impairment?

The Bottom Line

  • Mild cognitive impairment (MCI) is considered a “middle step” between normal age-related issues and dementia.
  • Most people with MCI are able to function relatively well but have a higher risk of developing dementia compared to those without MCI.
  • None of the interventions tested so far (i.e. medications used in treating Alzheimer's, vitamins, exercise, memory training) have been effective in stopping the progression of MCI to dementia.

You can’t recall the name of your niece’s fiancé, who you met last summer, or you completely forgot about your last dental appointment. Occasional memory lapses are a natural part of the aging process and do not necessarily signal the onset of dementia, characterized by a progressive decline in mental abilities and the eventual reliance on caregivers for help completing everyday tasks.

Somewhere in the middle between normal age-related forgetfulness and dementias such as Alzheimer’s disease, is mild cognitive impairment (MCI). Approximately 19% of adults over the age of 65 are diagnosed with this condition.(1) They may have some noticeable difficulties with memory, thinking, language and/or judgement, but the problems aren’t generally serious enough to interfere with daily living.(2) However what is worrisome is that close to half of those diagnosed with mild cognitive impairment will develop dementia within three years, compared with 3% of the population of the same age without this diagnosis.(3)

For that reason, people with MCI have been the focus of recent studies to determine whether proactive treatment can prevent dementia from developing. A 2013 systematic review, comprising 41 randomized controlled trials and more than 7,800 participants, is one of the first to examine the effects of various treatments on people with MCI.(4)

The primary treatment involved a category of medications called “cholinesterase inhibitors.” These drugs, known by trade names such as Aricept and Exelon, are currently used to treat symptoms in people with Alzheimer’s disease. Other interventions included vitamins, exercise and memory training.

According to the research...

Disappointingly, the studies included in the review indicated that cholinesterase inhibitors do not improve symptoms in people with mild cognitive impairment, nor do they prevent the onset of dementia.

There was no strong evidence that any of the other interventions examined were effective in improving cognitive function or preventing further declines. The review highlights the need for further study and research into alternate therapies.


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Author Details

References

  1. Lopez OL, Kuller LH, Becker JT, et al. Incidence of dementia in mild cognitive impairment in the cardiovascular health study cognition study. Arch Neurol. 2007;64:416-20.
  2. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256:183-94.
  3. Tschanz JT, Welsh-Bohmer KA, Lyketsos CG, et al. Conversion to dementia from mild cognitive disorder – The Cache County Study. Neorology. 2006;67:229-34.
  4. Cooper C, Li R, Lyketsos C, et al. Treatment for mild cognitive impairment: Systematic review. BJP. 2013;203:255-64.

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