Vol 5 n° 1 - Dementia
Past issues Contributors How to publish Contributions and comments Home
 
hile promising therapeutic strategies are being explored, our capacity to diagnose dementias early in their evolution remains poor. Degenerative dementias are insidious and progressive in nature. It is therefore conceivable that a dementia picture is preceded by a “preclinical state” (ie, pathognomonic cerebral lesions coexisting  with  normal  cognition)  as  described  in Alzheimer’s disease (AD),1,2 followed by mild deficits first experienced by patients themselves, then suspected by their family members, and eventually demonstrated through neuropsychological examination. It is generally assumed that normal aging involves cogni- tive changes, displaying large inter- and intraindividual variability.3 Some studies challenged this common view, showing that the use of strict criteria for the inclusion of cognitively normal subjects in longitudinal studies demon- Keywords: aging; cognition; dementia; Alzheimer’s disease; treatment Author   affiliations:   Director   of   Research   and   Development, FORENAP, Rouffach, France Address for correspondence: FORENAP, Institute for Research in Neuroscience and Neuropsychiatry, BP29, 68250 Rouffach, France (e-mail: christian.gilles@forenap.asso.fr) C l i n i c a l   r e s e a r c h 6 1 Age-related mild cognitive deficit: a ready-to-use concept? Christian Gilles, MD W For better management of mild cognitive impairment in elderly patients, clinicians should be provided with instruments to detect early changes and predict their progression. To define this cognitive status between optimal and pathological aging, many concepts have been proposed, which actually describe various conditions and provide more or less precise criteria, leaving room for variable implementation. As a consequence, application of these criteria gave highly variable prevalence rates. Neuropathological studies indicate that the different criteria have variable power in detecting incipi- ent Alzheimer’s disease (AD) and suggest that the transition between mild cognitive impairment and AD is not merely quantitative. Follow-up studies have produced, according to the criteria used, a 2.5% to 16.6% annual rate for pro- gression toward dementia, and have also shown that the criteria differ in their stability and predictive power. Baseline cognitive performances have some predictive value, but are difficult to apply in first-line medicine. Investigational tech- niques (structural and functional imaging, magnetic resonance spectroscopy, magnetization transfer imaging, cerebrospinal fluid neuro-chemistry, and apolipoprotein E genotype) are promising tools in the early diagnosis of AD, which remains the most frequent type of dementia in elderly people and probably the most frequent type developed by patients with mild cognitive deficit. The final goal is to offer early treatment to those patients who will evolve towards dementia, once they can be identified. In the case of AD, recent findings question the adequacy of cholinergic replacement therapies. In its current state, the criteria for mild cognitive deficit are hardly transferable to first-line medicine. However, dissemi- nating the concept could help increase the sensitivity of general practitioners to the importance of cognitive complaints and signs in their elderly patients. Dialogues Clin Neurosci. 2003;5:61-76.