The Outcome of Elderly Patients with Cognitive Complaints but Normal Neuropsychological Tests

Issue title: Similarities and Differences Between Mild Cognitive Impairment and Alzheimer's Disease

Guest editors: Mark A. Lovell

Article type: Research Article

Authors: Nunes, Teresa^{a; 1} | Fragata, Isabel^{a; 1} | Ribeiro, Filipa^b | Palma, Teresa^a | Maroco, João^b | Cannas, Jorge^a | Secca, Mário^a | Menezes, Cristina^a | Carmo, Isabel^c | Cunha, Gil^d | Branco, Miguel Castelo^d | Guerreiro, Manuela^{e; f} | de Mendonça, Alexandre^{e; g; *}

Affiliations: [a] Magnetic Resonance Centre of Caselas, Lisbon, Portugal | [b] Instituto Superior de Psicologia Aplicada, Lisbon, Portugal | [c] Hospital Egas Moniz, Lisbon, Portugal | [d] IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal | [e] Dementia Clinics, Institute of Molecular Medicine and Faculty of Medicine, Lisbon, Portugal | [f] Laboratory of Language, Institute of Molecular Medicine and Faculty of Medicine, Lisbon, Portugal | [g] Laboratory of Neurosciences, Institute of Molecular Medicine and Faculty of Medicine, Lisbon, Portugal | Sanders-Brown Center on Aging and Alzheimer's Disease Center, Department of Chemistry, University of Kentucky, Lexington, Kentucky, USA

Correspondence: [*] Corresponding author: Alexandre de Mendonça, Laboratory of Neurosciences, Institute of Molecular Medicine, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal. Tel.: +35 1217985183; Fax: +35 1217999454; E-mail: [email protected].

Note: [1] These authors contributed equally to the paper.

Abstract: Elderly patients may present with prominent cognitive complaints and have performances in neuropsychological tests within the normal range for the age and education, and thus do not fulfill the criteria for mild cognitive impairment (MCI). There is insufficient evidence to support the clinical decision in these cases (“pre-MCI”). Forty-three subjects, 11 controls, 15 “pre-MCI,” and 17 MCI, were followed for about three and half years with neuropsychological testing and magnetic resonance imaging including volumetric measurements of the hippocampus and amygdala. Two of the “pre-MCI” subjects suffered cognitive and functional deterioration and were diagnosed with dementia. Although the “pre-MCI” subjects as a group had no significant deterioration in neuropsychological tests, they suffered a decline in the total hippocampal volume (P=0.04) along the follow-up time. In contrast, all control subjects remained stable and had no volumetric decreases. As expected, MCI patients underwent significant deterioration in several neuropsychological tests, often progressed to Alzheimer's disease, and showed decreases both in total hippocampal and amygdalar volumes. Elderly people presenting with cognitive complaints may be in an initial phase of a degenerative disorder and should be followed clinically, even if they have normal neuropsychological tests.

Keywords: Aging, Alzheimer's disease, amygdala, dementia, hippocampus, magnetic resonance imaging, mild cognitive impairment (MCI), pre-MCI, volumetry

DOI: 10.3233/JAD-2010-1210

Journal: Journal of Alzheimer's Disease, vol. 19, no. 1, pp. 137-145, 2010