如何诊断MCI课件.ppt

1、如何诊断MCI浙大医学院附属二院神经科浙大医学院附属二院神经科神经心理室神经心理室R.C. Peterson,mild cognitive impairment as a diagnostic entity, Journal of internal medicin 256, 183194The author is from the department of neurology, Alzheimers research center, Mayo clincal college of Medicine, Rochester, MN, USACriteria for amnestic mild c

2、ognitive impairment1. Memory complaint usually corroborated by an informan2. Objective memory impairment for age3. Essentially preserved general cognitive funtion4. Largely intact functional activities5. Not dementedAbout the first criterionThe first criterion refers to the subjective memory complai

3、nt. This is meant to capture the notion of a change in performance.Ideally this should be corroborated by an informant, but occasionally this can be difficult .This criterion is soft and may be a challenge to implement.It is critical for the purpose of excluding individualWith lifelong static cognit

4、ive deflicit.About the second criterionThe second criterion refers to a objective memory impairment for age.This can be fulfilled with the assistance of neuropsychological testing, but once again, no particular test or cutoff score is specified.About the second criterionIn the original description o

5、f MCI cohort followed at the Mayo Clinic, the MCI groups mean performance was 1.5 SD below their age-mate. However this is not a cutoff score, nearly half of the group had memory performance falling somewhat 1.5 SD below the mean.This criterion should be interpreted in conjunction with the first cri

6、terion.About the second criterionThe memory complaint is meant to represent a change in function for the person,The second criterion corroborate the complaint by attesting to and an actual impairment in performance.The clinician may be challenged by persons who are of either high intellect whose per

7、formance is now in the statistically normal range, but this level of performance represents a change for that person, and by the person with a low education whose lower cognitive performance may not represent a change.About the second criterionThe preferable approach to this challenge is to allow th

8、e clinician to use judgement in combining all of these criteria.A precise history from the patient and an informant coupled with neuropsychological testing can be invaluable.About the third criterion The third criterion regarding general intellectual function refers to the other nonmemory cognitive

9、domain, eg, language,executive function, visuospatial skill, in a fashion similar to the constructs of apraxia and agnosia were use in the diagnosis of AD.About the third criterionPerformance in these domain should be judged relative to age-appropriate standards, but still no special instruments or

10、cutoff scores are predetermined.Neuropsychological testing can be very useful in this context in making these determinations, but ultimately, the judgement of the clincian is require. About the fourth criterionThe essentially normal activities of daily living criterion can be fulfill largely through

11、 the history from the subject and preferable from the an informant as well.Often there are minor inconveniences in daily function because of the memory deficit, but these are generally believed to be of insufficient severity to constitute a major disability.About the fourth criterionThe criterion re

12、quires that the functional impairment be due to the cognitive reasons, and this can be difficult to determine in old subjects who may have several medical comorbidities and physical limitations.This underscores the necessity of a clinical assimilation of all of the data available.About the fifth cri

13、terion Finally the last criterion not demented,is also made on the basis of the clinicians best judgement. Many of these subjects will have a slight degree of general cognitive impairment, but it will not be of sufficient magnitude to be clinically significant. In general, these subjects appear more

14、 normal than not. The distinction is between normal ageing and MCI rather than between MCI and AD.Proposed diagnostic schemeHow to generate a diagnosis of MCI in a new patientBased on the history and a mental status exam, the doctor makes a judgement as to normal cognition or suspected dementia.For

15、example, if the person has a clear impairment in functional activities and scores 20 of 30 on the MMSE, this person will likely be demented. Although, if the person scores 29 of 30 on the MMSE and shows no impairments in complex activities of daily living, despite the subjective complaint, the perso

16、n may be normal.How to generate a diagnosis of MCI in a new patientOnce the clinician has determined that the person is neither normal nor demented,the next decision involoves assessing a decline in function.This is done through a careful history from the patient and preferably a collateral source.I

17、f there is evidence for a decline in cognition, the clinician must the determine if this change in cognition constitutes a significant impairment infunctional activities such that the person might be considered for having very mild dementia.How to generate a diagnosis of MCI in a new patientIf the f

18、unction impairment is not significant, the clinician may entertain the diagnosis of MCI and the next task is to identify the subtype.The clinician should next assess memory more carefully, prehaps with a word list learning procedure or paragraph recall.Cognitive complaint Not normal for age Not dema

19、ntia Cognitive decline Essentially normal functional activities MCI Memory impairment?Amnestic MCI Non-Amnestic MCI Memory impairment only Single nonmemory Cognitive domain impairmentAmnestic MCISingle domainAmnestic MCIMultiple domain Non-amnestic MCISingle domain Non-amnestic MCIMultple domain yes

20、noyesnoyesnoyesyesClassification of clincal subtypes of mild cognitive impairment with presumed aetiologyDegeneration VascularPsychiatrictraumaMCI amnesticADDepressionMultple MCI+AmnADVaDDepressionMultple MCI-AmnDLBVaDMCI single nonmemory DomainFTDDLB（一 ） a-MCI的诊断标准国内诊断标准:肖世富等的诊断标准为：（1）年龄5580岁（2）主观感觉有记忆力减退（3）客观检查有轻度认知功能损害的证据（4）生活及社会功能降低，ADL3个月（7）不符合痴呆的诊断标准。