MCI-plus: leichte kognitive Beeinträchtigung mit rascher Progredienz

Zusammenfassung

Die leichte kognitive Beeinträchtigung (Mild Cognitive Impairment, MCI) ist im höheren Lebensalter häufig und viele Betroffene weisen Prädiktoren für eine rasche Progression zur Demenz auf („MCI-plus”). Aufgrund demografischer Veränderungen und eines anwachsenden Problembewusstseins in der Bevölkerung wird MCI-plus in den nächsten Jahren in vielen Bereichen der Medizin deutlich weiter an Bedeutung gewinnen, während sich die Möglichkeiten einer Frühdiagnose schneller entwickeln als die Einführung kausaler Interventionen gegen zugrunde liegende neurodegenerative und vaskuläre Hirnveränderungen. Bei den meisten dieser Patienten bestehen aber symptomatisch beeinflussbare oder bereits heute kausal behandelbare Grund- und Begleiterkrankungen. Wir gehen auf neuropsychologische und psychopharmakologische Therapiemöglichkeiten ein, sowie auf die Chancen einer konsequenten somatischen Behandlung relevanter internistischer und neurologischer Faktoren.

Summary

Mild Cognitive Impairment (MCI) is a prevalent problem in the elderly and many patients show predictors of rapid cognitive decline („MCI-plus”). MCI-plus represents a syndrome with growing importance in an ageing society, which will increasingly affect primary medicine and most other clinical specialties. We will have to face the dilemma of fast progress in the field of neurodiagnostics with innovative therapeutic strategies lagging behind. Psychological and medical co-morbidity in MCI-plus will therefore offer important opportunities to delay and to avoid the manifestation of dementia. We will review and discuss current training and treatment options including symptomatic and causal interventions.

Schlüsselwörter

leichte kognitive Beeinträchtigung - mild cognitive impairment - MCI-plus - Neuropsychologie - Progression - Prävention - Demenz - Morbus Alzheimer - Alzheimer-Phobie

Keywords

mild cognitive impairment - MCI-plus - neuropsychology - progression - prevention - dementia - Alzheimer’s disease - Alzheimer phobia

Literatur

• 1 Adler G, Chwalek K, Jajcevic A. et al . Six-month course of mild cognitive impairment and affective symptoms in late-life depression.  Eur Psychiat. 2004;  19 502-505
• 2 Aisen P S, Thal L J, Ferris S H. et al . Rofecoxib in patients with mild cognitive impairment: further analyses of data from a randomized, double-blind trial.  Curr Alzheimer Ther. 2008;  5 73-82
• 3 Artero S, Ancelin M L, Portet F. et al . Risk profiles for mild cognitive impairment and progression to dementia are gender specific.  J Neurol Neurosurg Psychiatry. 2008;  , doi: 10.1136/jnnp.2007.136903
• 4 Barnes D E, Alexopoulos G S, Lopez O. et al . Depressive symptoms, vascular disease and mild cognitive impairment.  Arch Gen Psychiat. 2006;  63 273-280
• 5 Baumgart P, Helgenberger F, Weyerer S. et al . The course of cognition and depression in elderly patients with affective disturbances and mild cognitive impairment.  Int J Geriatr Psychiatry. 1995;  10 20-21
• 6 Belleville S, Gilbert B, Fontaine F. et al . Improvement of episodic memory in persons with mild cognitive impairment and healthy older adults: evidence from a cognitive intervention program.  Dement Geriat Cogn Disord. 2006;  22 486-499
• 7 Bhalla R K, Butters M A, Mulsant B H. et al . Persistence of neuropsychologic deficits in the remitted state of late-life depression.  Am J Geriatr Psychiat. 2006;  14 419-427
• 8 Bickel H, Mösch E, Seigerschmidt E, Siemen M, Förstl H. Prevalence and persistence of mild cognitive impairment among elderly patients in general hospitals.  Dement Geriatr Cogn Disord. 2006;  21 242-50
• 9 Bickel H. Rauchen und Alkoholkonsum als Risikofaktoren einer Demenz im Alter.  Sucht. 2006;  52 48-59
• 10 Bosch J, Yusuf S, Pogue J. et al . Use of ramipril in preventing stroke: double-blind randomised trial.  Brit J Med. 2002;  324 699-702
• 11 Cipriani G, Bianchetti A, Trabucchi M. Outcomes of computer-based cognitive rehabilitation program on Alzheimer’s disease patients compared with those on patients affected by mild cognitive impairment.  Arch Gerontol Geriatr. 2006;  43 327-35
• 12 Clarnette R M, Almeida O P, Forstl H, Paton A, Martins R. Clinical characteristics of individuals with subjective memory loss in Western Australia.  Int J Geriat Psychiat. 2001;  16 168-174
• 13 Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised Placebo-controlled trial.  Lancet. 2003;  361 2005-2016
• 14 Dufouil C, Chalmers J, Coskun O. et al . PROGRESS MRI Substudy Investigators. Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke: the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy.  Circulation. 2005;  112 1644-50
• 15 Egert S, Wagenpfeil S, Förstl H. Cholinesterase-Inhibitoren und Alzheimer Demenz: Meat-Analyse zu Wirksamkeitsnachweis, Ursprung und Ergebnisverzerrung in publizierten Studien.  Dtsch Med Wochenschr. 2007;  132 1207-13
• 16 Etgen T, Brönner M, Sander D. et al .Somatische Faktoren bei leichter kognitiver Störung. Fortschr Neurol Psychiat 2009, in press
• 17 Feldman H H, Ferris S, Winblad B. et al . Effect of rivastigmine on delay of diagnosis of Alzheimer’s disease from mild cognitive impairment: the InDDEx study.  Lancet Neurol. 2007;  6 501-12
• 18 Forette F, Seux M L, Staessen J A. et al . Prevention of dementia in randomised double-blind Placebo-controlled Systolic Hypertension in Europe (SYST-EUR) trial.  Lancet. 1998;  352 1347-51
• 19 Förstl H, Bickel H, Frölich L. et al . Leichte kognitive Beeinträchtigung mit Vorzeichen rascher Verschlechterung.  Dtsch Med Wochenschr. 2007;  133 431-436
• 20 Förstl H. Behandlungs- und Versorgungsstrategien bei Alzheimer und verwandten Demenzen.  Nervenarzt. 2008;  79 617-29
• 21 Furio A M, Brusco L I, Cardinali D P. Possbile therapeutic value of melatonin in mild cognitive impairment: a retrospective study.  J Pineal Res. 2007;  43 404-9
• 22 Gomez-Isla T, Blesa R, Boada M. et al . A randomized double-blind, placebo controlled trial of triflusal in mild cognitive impairment.  Alzh Dis Assoc Disord. 2008;  22 21-9
• 23 Kivipelto M, Ngandu T, Laatikainen T, Winblad B, Soininen H, Tuomilehto J. Risk score fort he prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study.  Lancet Neurology. 2006;  5 735-741
• 24 Lee J S, Potter G G, Wagner H R. et al . Persistent mild cognitive impairment in geriatric depression.  Int Psychogeriatr. 2007;  19 125-135
• 25 Lyle S, Grizzell M, Willmott S. et al . Treatment of a whole population sample of Alzheimer’s disease with donepezil over a 4-year period: lessons learned.  Dementia Geriat Cogn Disord. 2008;  25 226-31
• 26 McMahon J A, Green T J, Skeaff C M, Knight R G, Mann J I, Williams S M. A controlled trial of homocysteine lowering and cognitive performance.  N Engl J Med. 2006;  354 2764-2772
• 27 Modrego P J, Ferrandez J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type; a prospective cohort study.  Arch Neurol. 2004;  61 1290-1293
• 28 Mowla A, Mosavinasab M, Hagshenas H, Haghighi A B. Does serotonin augmentation have any effect on cognition and activities of daily living in Alzheimer’s dementia? A double blind, placebo-controlled clinical trial.  J Clin Psychopharmacol. 2007;  27 484-87
• 29 Olazarán J, Muñiz R, Reisberg B. et al . Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease.  Neurology. 2004;  63 2348-53
• 30 Ownby R L, Crocco E, Acevedo A. et al . Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis.  Arch Gen Psychiatry. 2006;  63 530-538
• 31 Rapp M A, Schnaider-Beeri M, Grossman H T. et al . Increased plaques and tangles in patients with Alzheimer’s disease with a lifetime history of major depression.  Arch Gen Psychiat. 2006;  63 161-167
• 32 Rapp S, Brenes G, Marsh A P. Memory enhancement training for older adults with mild cognitive impairment: a preliminary study.  Aging Ment Health. 2002;  6 5-11
• 33 Ravaglia G, Forti P, Lucicesare A. et al . Physical activity and dementia risk in the elderly: findings from a prospective Italian study.  Neurology. 2008;  70 1786-94
• 34 Reger M A, Watson G S, Green P S. et al . Intranasal insulin improves cognition and modulates beta-amyloid in early AD.  Neurology. 2008;  5 440-8
• 35 Riedel O, Klotsche J, Spottke A. et al . Cognitive impairment in 873 patients with idiopathic Parkinson’s diease: results from the German Study on Epidemiology of Parkinson’s Disease with Dementia (GEPAD).  J Neurol. 2008;  2 255-64
• 36 Rozzini L, Costardi D, Chilovi B V. et al . Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors.  Int J Geriat Psychiat. 2007;  22 356-60
• 37 Saxby B K, Harrington F, Wesnes K A. et al . Candesartan and cognitive decline in older patients with hypertension: a sub-study of the SCOPE trial.  Neurology. 2008;  70 1858-66
• 38 Schönknecht P, Pantel J, Kaiser E. et al . Increased tau protein differentiates mild cognitive impairment from geriatric depression and predicts conversion to dementia.  Neurosci Lett. 2007;  416 39-42
• 39 Shepherd J, Blauw G J, Murphy M B, Bollen E L. et al . Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial.  Lancet. 2002;  360 1623-1630
• 40 Solfrizzi V, Colaciccio A M, D’Intonron A. et al . Dietary fatty acids intakes and rate of mild cognitive impairment. The Italian Longitudinal Study on Aging.  Exp Gerontol. 2006;  41 619-27
• 41 Sun X, Steffens D C, Au R. et al . Amyloid-associated depression: a prodromal depression of Alzheimer disease?.  Arch Gen Psychiat. 2008;  65 542-50
• 42 Troyer A K, Murphy K J, Anderson N D, Moscovitch M, Craik F IM. Changing everyday memory behaviour in amnestic mild cognitive impairment: A randomized controlled trial.  Neuropsychol Rehabilitation. 2008;  18 65-88
• 43 Tzourio C, Anderson C, Chapman N. et al . Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease.  Arch Intern Med. 2003;  163 1069-75
• 44 Marum, R. Current and future therapies in Alzheimer’s disease.  Fundament Clin Pharmacol. 2008;  22 265-274
• 45 Van Uffelen J G, Chinapaw M J, van Mechelen W, Hopman-Rock M. Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial.  Brit J Sports Med. 2008;  42 344-51
• 46 Velandai K, Stephen J, Quinn S J, Donnan G A, Saling M M, Thrift A G. Long-Term Cognitive Transitions, Rates of Cognitive Change, and Predictors of Incident Dementia in a Population-Based First-Ever Stroke Cohort.  Stroke. 2006;  37 2479-2483
• 47 Werheid K, Thöne-Otto A IT. Kognitives Training bei Alzheimer-Demenz.  Nervenarzt. 2006;  77 549-557
• 48 Weyerer S, Eifflaender-Gorfer S, Köhler L. et al .Prevalence and risk factors for depression in non-demented primary care attenders aged 75 years and older. J Affect Dis 2009, in press
• 49 Winblad B, Gauthier S, Scinto L. et al . Safety and efficacy of galantamine in subjects with mild cognitive impairment.  Neurology. 2008;  27 2024-35