Die leichte kognitive Beeinträchtigung

J. Pantel; J. Schröder

doi:10.1055/s-0038-1626831

Nervenheilkunde, Table of Contents

Nervenheilkunde 2007; 26(01/02): 49-58
DOI: 10.1055/s-0038-1626831

Original- und Übersichtsarbeiten - Original and Review Articles

Schattauer GmbH

Die leichte kognitive Beeinträchtigung

Epidemiologie, Symptomatik und klinisches ManagementMild cognitive impairmentEpidemiology, symptomatology and clinical management

J. Pantel

¹Klinik für Psychiatrie, Psychosomatik und Psychotherapie der Johann Wolfgang Goethe-Universität Frankfurt

,

J. Schröder

²Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Sektion Gerontopsychiatrie, Universität Heidelberg

› Author Affiliations

Abstract

Zusammenfassung

Klagen über kognitive Beeinträchtigungen sind ein häufi ges Symptom in der älteren Bevölkerung und werden ent sprechend regelmäßig in der ärztlichen Sprechstunde vor getragen. In diesem Kontext bezeichnet der Begriffjeichte kognitive Beeinträchtigung” ein Syndrom mit diskreten, aber konsistent nachweisbaren kognitiven Defiziten, die je doch noch nicht den Schweregrad einer Demenz erfüllen. Epidemiologischen Studien zufolge ist die leichte kognitive Beeinträchtigung mit einem erhöhten Risiko assoziiert, in den folgenden Jahren eine manifeste Demenz zu ent wickeln. Der vorliegende Beitrag gibt eine Übersicht über aktuelle Konzeptezur Erfassung der leichten kognitiven Be einträchtigung, ihrer Verlaufsdynamik sowie assoziierten neurobiologischen Veränderungen, die auch in der Früh diagnostik einer Demenzerkrankung Relevanz besitzen. Darüber hinaus werden Hinweise für ein strukturiertes Vor gehen in der Diagnostik sowie bezüglich des therapeuti schen Managements dieses für viele Betroffenen mit ho hem Leidensdruck einhergehenden Syndroms gegeben.

Summary

Subjective complaints about cognitive deficits are a frequent symptom among the aged population. Accordingly, physicians are regularly confronted with elderly patients describing themselves as cognitively impaired. In this con text the term mild cognitive impairment (MCI) defines a syndrome with mild but persistent cognitive deficits which do not yet meet the diagnostic criteria for manifest dementia. According to epidemiological studies MCI is associated with an increased risk to develop Alzheimer’s dementia (AD) at follow up. This article reviews current concepts for the diagnosis of MCI as well as its natural course and associated neurobiological findings. The latter are also relevant to increase the sensitivity and specificity of an early (preclinical) diagnosis of AD. Furthermore, recommendations for a structured diagnostic approach and therapeutic management are given.

Schlüsselwörter

Leichte kognitive Beeinträchtigung - Alzheimer-Demenz - Konversion zur Demenz - Sekundärprävention

Keywords

Mild Cognitive Impairment - Alzheimer’s dementia - conver sion to dementia - secondary prevention

Full Text

References

Literatur
1 Alzheimer A. Über eine eigenartige Erkrankung der Hirnrinde. Allg Z Psychiatr 1907; 64: 146-8.
2 Arendt T, Holzer M, Gertz HJ, Bruckner MK. Cortical load of PHF-tauinAlzheimer’s disease is cor related to cholineergic dysfunction. J Neural Transm 1999; 106 (5–6) 513-23.
3 Barker A, Jones R, Jennison C. A prevalence study of age-associated memory impairment. Br J Psy chiatry 1995; 167: 642-648.
4 Barth S, Pantel J, Schönknecht P, Schröder J. Neuropsychologische Profile in der Demenzdiagnos tik: Eine Untersuchung mit der CERAD-NP-Testbatterie. Fortschr Neurol Psych 2005; 73: 1-9.
5 Belleville S, Gilbert B, Fontaine F, Gagnon L, Menard E, Gauthier S. Improvement of episodic memory in persons with mild cognitive impairment an healthy older adults: Evidence from a cognitive intervention program. Dement Geriatr Cogn Disord 2006; 22: 486-99.
6 Bernick C, Katz R, Smith NL, Rapp S, Bhadelia R, Carlson M, Kuller L. Statins and cognitive function in the elderly. The cardiovascular health study. Neurology 2005; 65: 1388-1394.
7 Beyreuther K. Molekularbiologie der Alzheimer Demenz. In Förstl H. (Hrsg) Lehrbuch der Gerontopsychiatrie. 1997. Stuttgart: Enke; 41-3.
8 Blennow K, Hampel H. CSF markers for incipient Alzheimer’s disease. Lancet neurol 2003; 02: 605-13.
9 Braak H, Braak E, Bohl J. Staging of Alzheimer related cortical destruction. Eur Neurol 1993; 33: 403-8.
10 Bruscoli M, Lovestone S. Is MCI really just early dementia? A systematic review of conversion stu dies. Int Psychogeriatr 2004; 16 (02) 129-40.
11 Busse A, Bischkopf J, Riedel-Heller SG, Anger-meyer MC. Mild cognitive impairment: preva lence and incidence according to different diagnostic criteria. Br J Psychiatry 2003; 182: 449-54.
12 Convit A, de Leon MJ, Tarshish C, de Santi S, Tsui W, Rusinek H, George A. Specific hippocampal volume reductions in individuals at risk for Alzheimer’s disease. Neurobiol Aging 1997; 18: 131-8.
13 Döbert N, Pantel J, Frölich L, Hamscho N, Menzel FGrünwald. Diagnostic value of FDG_PET and HMPAO-SPET in patients with early dementia and MCI: Metabolic index and perfusion index. Dement Geriatr Cognit Disord 2005; 20: 63-70.
14 Elias MF, Beiser A, Wolf PA, Au R, White RF, D’Agostino RB. The preclinical phase of Alzhei mer disease. A 22-year prospective study of the Framingham cohort. Arch Neurol 2000; 57: 808-13.
15 Erhardt T, Hampel H, Hegerl U, Möller HJ. Das Verhaltenstherapeutische Kompetenztraining VKT eine spezifische Intervention für Patienten mit einer beginnenden Alzheimer-Demenz. Z Ge rontol Geriatr 1998; 31: 112-9.
16 Herholz K, Salmon E, Perani D, Baron JC, Holthoff V, Frölich L, Schönknecht P, Ito K, Mielke R, Kalbe E, Zündorf G, Delbuecke X, Pelati O, Anchisi D, Fazio F, Kerrouche N, Beuthien-Baumann B, Menzel C, Schröder J, Kato T, Arahata Y, Henze M, Heiss WD. Discrimination between Alzhei mer Dementia and Controls by Automated Analy sis of Multicenter FDG PET. Neuroimage 2002; 17: 302-16.
17 Jack Jr CR, Petersen RC, Xu YC, O’Brien PC, Smith GE, Ivnik RJ, Boeve BF, Waring SC, Tange EGlos, Kokmen E. Prediction of AD with MRIbased hippocampal volume in mild cognitive impairment. Neurology 1999; 52: 1397-403.
18 Jensen M, Schröder J, Blomberg M, Engvall B, Pantel J, Ida N, Basun H, Wahlund L-O, Werle E, Jauss M, Beyreuther K, Lannfelt L, Hartmann T. Cerebrospinal fluid ßA42 is increased early in sporadic Alzheimer s disease and declines with disease progression. Ann Neurol 1999; 45: 504-11.
19 Kaye JA, Swihart T, Howieson D, Dame A, Moore MM, Karnos T, Camicioli R, Ball M, Oken B, Sexton G. Volume loss of the hippocampus and temporal lobe in healthy elderly persons destined to develop dementia. Neurology 1997; 48: 1297-304.
20 Koivisto K, Reinikainen KJ, Hanninen T, Vanhanen M, Helkala EL, Mykkanen L, Laakso M, Pyorala K, Riekkinen Sr PJ. Prevalence of age-associatedmemory impairment in arandomly selected population from eastern Finland. Neurology 1995; 45: 741-7.
21 Kral VA. Senescent forgetfulness: benign and ma lignant. Can Med Assoc J 1962; 86: 257-260.
22 Laakso MP, Soininen H, Partanen K, Lehtovirta M, Hallikainen M, Hanninen T, Helkala EL, Vainio P, Riekkinen Sr PJ. MRI of the hippocampus in Alzheimer’s disease: sensitivity, specificity, and analysis of the Incorrectly classified subjects. Neurobiol Aging 1998; 19: 23-31.
23 Larrabee GJ, Crook TH. Estimates prevalence of age-associated memory impairment derived from standardised tests of memory function. Int Psychogeriatr 1994; 06: 95-104.
24 Larson EB, Wang L, Bowen JD, MacCormick WC, Teri L, Crane P, Kukull W. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med 2006; 144 (02) 73-81.
25 La Rue A. Patterns of performance on the fuld object memory evaluation in elderly inpatients with depression or dementia. J Clin Exp Neuropsychol 1989; Aug; 11 (04) 409-22.
26 Laske C, Morawetz C, Buchkremer G, Wormstall H. Präventive Maßnahmen bei demenziellen Er krankung. Deutsches Arzteblatt 2005; 102: 1210-6.
27 Levy R. Aging-associated cognitive decline. Int Psychogeriatr 1994; 06: 63-8.
28 Marx J. Preventing Alzheimer’s: a lifelong commitment?. Science 2005; 309: 864-6.
29 Mayeux R, Tang MX, Jacobs DM, Manly J, Bell K, Merchant C, Small SA, Stern Y, Wisniewski HM, Mehta PD. Plasma amyloid ß-peptide 1-42 and incipient Alzheimer’s disease. Ann Neurol 1999; 46: 412-6.
30 Näslund J, Haroutunian V, Mohs R, Davis KL, Davies P, Greengard P, Buxbaum JD. Correlation bet ween elevated levels of amyloid ß-peptide in the brain and cognitive decline. JAMA 2000; 283: 1571-7.
31 Pantel J, Kratz B, Essig M, Schröder J. Parahippocampal volume deficits in subjects with aging-as sociated cognitive decline. Am J Psychiatry 2003; 160: 379-82.
32 Pantel J, Schöder J. Zerebrale Korrelate kli nischer und neuropsychologischer Veränderun gen in den Verlaufsstadien der Alzheimer-De menz. Untersuchungen mit der quantitativen Magnetresonanztomographie. 2006. Darmstadt: Steinkopff.;
33 Petersen RC, Doody R, Kurz A, Mohs RC, Morris J, Rabins PV, Ritchie K, Rossor M, Thal L, Winblad B. Current concepts in mild cognitive impairment. ArchNeurol 2001; 58 (12) 1985-92.
34 Petersen RC, Smith GE, Waring SC, Ivnik RJ, Kokmen E, Tangalos EG. Aging, memory, and mild cognitive impairment. Int Psychogeriatr 1997; (Suppl. 09) 65-9.
35 Petersen RC, Thomas RG, Grundman M, Bennett Doody R, Ferris S, Galasko D, Jin S, Kaye J, Levey A, Pfeiffer E, Sano M, van Dyck CH, Thal LJ. Vitamin E and Donepezil for the treatment ofmild cognitive impairment. N Engl J Med 2005; 352: 2379-88.
36 Richards M, Touchon J, Ledesert B, Ritchie K. Cognitive decline in ageing: are AAMI and AACD distinct entities?. Int J Geriatr Psychiatry 1999; 14: 534-40.
37 Ritchie K, Arteron S, Touchon J. Classification criteria for mild cognitive impairment a popula tion-based validation study. Neurology 2001; 56: 37-42.
38 Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean diet and risk for Alzhei mer’s disease. Ann Neurol 2006; 59: 912-21.
39 Schönknecht P, Pantel J, Hartmann T, Werle E, Volkmann M, Essig M, Amann M, Zanabili N, Bardenheuer H, Hunt A, Schröder J. Cerebrospinal fluid tau levels in Alzheimer’s disease are elevated when compared to vascular dementia but do not correlate with measures of cerebral atrophy. PsychiatryResearch 2003; 120: 231-8.
40 Schönknecht P, Pantel J, Hunt A, Volkmann M, Buerger K, Hampel H, Schröder J. Tau protein phosphorylated at threonine 181 is increased in incipient and manifest Alzheimer’s disease but not in vascular dementia. Neuroscience Letters 2003; 339: 172-4.
41 Schönknecht P, Pantel J, Kruse A, Schröder J. Pre valence andnatural course of aging-associated co gnitive decline in a population based sample of “young-old” subjects. Am J Psychiatry 2005; 11: 2071-7.
42 Schröder J, Pantel J, Ida N, Essig M, Hartmann T, Knopp MV, Schad LR, Sandbrink R, Sauer H, Masters CL, Beyreuther K. Cerebral changes and cerebrospinal fluid beta-amyloid in Alzheimer’s disease: A study with quantitative magnetic resonance imaging. Mol Psychiatry 1997; 02: 505-7.
43 Schröder J, Kratz B, Pantel J, Minnemann E, Lehr U, Sauer H. Prevalence of mild cognitive impair ment in an elderly community sample. J Neural Transm 1998; 54: 51-9.
44 Schröder J, Pantel J, Förstl H. Demenzielle Er krankungen Ein Überblick. In: Kruse A, Martin M. (Hg.) Enzyklopädie der Gerontologie. Zü rich: Huber; 2004: 224-39.
45 Small BJ, Mobly JL, Laukka EJ, Jones S, Backman L. Cognitive deficits in preclinical Alzhei mer’s disease. Acta Neurol Scand Suppl 2003; 179: 29-33.
46 Soininen HS, Partanen K, Pitkänen A, Vainio P, Hänninen T, Hallikainen M, Koivisto K, Riekkinen PJ. Volumetric MRI analysis of the amygdala and the hippocampus in subject with ageassociated memory impairment: correlation to visual and verbal memory. Neurology 1994; 44: 1660-8.
47 Verghese J, LeValley A, Derby C, Kuslansky G, Katz M, Hall C, Buschke H, Lipton RB. Leisure activities and the risk of amnestic mild cognitive impairment in the elderly. Neurology 2006; 66: 821-7.
48 Visser PJ, Scheltens P, Verhey FRJ, Schmand B, Launer LJ, Jolles J, Jonker C. Medial temporal lo be atrophy and memory dysfunction as predictors for dementia in subjects with mild cognitive impairment. Journal of Neurology 1999; 246: 477-85.
49 Wiltfang J, Lewczuk P, Riederer P, Grunbaltt E, Hock C, Scheltens P, Hampel H, Vanderstichele H, Iqbal K, Galasko D, Lannfelt L, Otto M, Esselmann H, Henkel AW, Kornhuber J, Blennow K. Consensus paper of the WFSBP task force on bio logical markers of dementia: the role of CSF and blodd analysis in the early and differential diagno sis of dementia. World J Biol Psychiatry 2005; 06: 69-84.
50 Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, Backman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC. Mild cognitive impairment beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004; 03: 240-6.
51 World Health Organization. The ICD-10 Classification of mental and Behavioural Disorders. Diagnostic criteria for research. Geneva: World Health Organization; 1992
52 Zonderman AB. Predicting Alzheimer’s disease in the Baltimore longitudinal study of aging. J Geriatr Psychiatry Neurol 2005; 18 (04) 192-5.