The mild cognitive impairment is a syndrome that may present cognitive deficits beyond what is considered normal, where there may or may not be interference with daily life and does not meet the criteria for dementia.
That is, mild cognitive impairment, as its name suggests, is a type of cognitive impairment that is characterized by being mild (the deficits are not very important), but are notorious enough not to be explained by normal aging of the child. brain.
People, as we get older, we lose our mental faculties. We lose speed of thought, we are less and less agile mentally, our ability to learn decreases, it may cost us more to remember things ...
However, this slight cognitive decline is not considered any type of disease, and is classified as "age-related cognitive impairment" (DECAE).
DECAE is considered a relatively benign phenomenon, and practically all of us present it (to a greater or lesser intensity) as we age. No one is spared from losing faculties with age.
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Mild cognitive impairment does not refer to benign aging of the human brain, but is considered a type of impairment greater than that seen in a DECAE.
Therefore, mild cognitive impairment would constitute those types of cognitive decline that are not purely associated with age and therefore are not considered "normal" but rather pathological..
Normally when we talk about pathological cognitive impairment, we are usually talking about dementia, such as Alzheimer's dementia or Parkinson's disease dementia.
However, mild cognitive impairment is not a dementia, it is a type of cognitive impairment less than that presented in any type of dementia syndrome.
Mild cognitive impairment refers to those people who are neither cognitively normal (they have a deterioration greater than what should be expected due to age) nor insane (they have a less deterioration than people with Dementia).
However, it has been shown that not all people with mild cognitive impairment end up suffering from dementia syndrome.
More specifically, taking into account the data provided by Iñiguez in 2006, only between 10% and 15% of patients with mild cognitive impairment end up developing a dementia syndrome.
In summary, mild cognitive impairment is a type of impairment greater than that considered "normal" but less than that for dementia syndromes.
In addition, this disease increases the probability of ending up suffering from a dementia syndrome from 1-2% (for healthy people) to 10-15% (for people with mild cognitive impairment).
Although the deficits of mild cognitive impairment are mild, the presentation of this disorder can vary and the type of cognitive decline can be of several forms.
Thus, currently 4 subtypes of mild cognitive impairment have been described, each with specific characteristics. Let's quickly review them.
A patient whose only cognitive complaint is related to a deficit in memory would be labeled in this subtype. It is the most frequent subtype and is characterized in that the person does not present any type of cognitive deficit beyond a slight memory loss.
For certain authors, this subtype of mild cognitive impairment could be considered a pre-Alzheimer's disease stage.
A patient with memory loss and complaints in other cognitive areas such as problem solving, word naming or attention and concentration difficulties would be framed in this subtype..
Multiple cognitive deficits may occur, but all of them of low intensity, so it could not be considered a dementia syndrome.
A patient without any type of alteration in his memory but with difficulties in other cognitive areas such as attention, concentration, language, calculation or problem solving would be diagnosed with non-amnesic mild cognitive impairment with affectations in multiple areas.
In this subtype, as in the previous one, multiple low-intensity cognitive deficits may occur, but with the difference that there is no memory loss.
Finally, a patient who, as in the previous case, does not present memory loss and only presents one of the other cognitive deficits described above, would be included within this subtype of mild cognitive impairment.
The diagnosis of mild cognitive impairment is usually complex, or since there are no precise and universally established criteria to detect this disorder.
The main requirement for the diagnosis is to present an evident cognitive deterioration through the neuropsychological examination (mental performance tests) without these meeting the criteria for dementia.
Despite the lack of stable diagnostic criteria to detect mild cognitive impairment, I will now comment on those proposed by the International Psychogeriatric Association, which in my opinion clarify several concepts:
Decreased cognitive ability at any age.
Decrease in cognitive ability stated by the patient or informant.
Gradual decrease of minimum duration of six months.
Any of the following areas may be affected:
Memory and Learning.
Attention and Concentration.
Thought.
Language.
Visuospatial function.
Decreased mental status assessment scores or neuropsychological tests.
This situation cannot be explained by the presence of Dementia or another medical cause..
The criteria for establishing the diagnosis of mild cognitive impairment are to present complaints of decline in cognitive abilities, that these are detectable through mental performance tests and that they are less severe than those of Dementia.
That is why being able to differentiate mild cognitive impairment from dementia is especially important, let's see how we can do it.
Dementia syndromes are characterized by memory impairment and other cognitive disturbances such as language, planning, problem solving, apraxia or agnosias.
The characteristics of mild cognitive impairment are practically the same as those of dementia, since in mild cognitive impairment both memory deficits and the other cognitive deficits that we have just discussed can be witnessed.
Thus, it is not possible to differentiate mild cognitive impairment from dementia by the type of alterations that the person presents, since they are the same in both pathologies, therefore, the differentiation can only be made through the severity of these.
Thus, the keys to differentiate mild cognitive impairment from dementia are the following:
Since mild cognitive impairment increases the risk of developing Alzheimer's dementia, current research has focused on determining markers for both mild cognitive impairment and Alzheimer's.
Although there are still no clear markers, there are several biological, behavioral, psychological and neuropsychological markers that allow us to differentiate both pathologies and predict which patients with mild cognitive impairment may develop dementia.
One of the main biomarkers of Alzheimer's disease (AD) are peptides in cerebrospinal fluid. In the neurons of people with Alzheimer's, higher amounts of the proteins Beta-amyloid, T-Tau and P-Tau have been detected.
When patients with mild cognitive impairment present high levels of these proteins in their brain, it is more than likely that they will develop AD, on the other hand, if they present normal levels of these proteins, the evolution towards AD becomes very unlikely.
A study carried out by Baquero in 2006 estimates that 62% of patients with mild cognitive impairment present some psychological or behavioral symptoms. The most common are depression and irritability.
Likewise, authors such as Lyketsos, Apostolova and Cummings, defend that symptoms such as apathy, anxiety and agitation (typical of depressions) increase the probability of developing AD in patients with mild cognitive impairment.
According to Íñieguez, those patients with mild cognitive impairment who present a fairly significant impairment of language and implicit memory or a notable alteration of episodic and working memory are more likely to develop AD than patients with mild cognitive impairment with another pattern of deficits.
Thus, by way of conclusion, it seems that the boundaries between mild cognitive impairment and dementia are not clearly defined..
Mild cognitive impairment could be defined as a low intensity cognitive decline that does not excessively reduce the person's day-to-day life, but which in some cases may represent a phase prior to a serious, progressive and chronic dementia disorder.
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