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Semin Neurol 2022; 42(02): 192-203
DOI: 10.1055/s-0042-1742486
DOI: 10.1055/s-0042-1742486
Review Article
Non-Pharmacological Treatments of Neuropsychiatric Symptoms in Mild Cognitive Impairment
Funding None.
Abstract
Mild cognitive impairment (MCI) is a syndrome defined by objective cognitive deficits that do not impact functional independence. Individuals with MCI develop dementia at an annual rate of 10 to 15%. Neuropsychiatric symptoms (NPS) are common non-cognitive features of neurocognitive disorders and have a major impact on the wellbeing and quality of life of affected individuals and their families. Non-pharmacological interventions for NPS are considered the first-line treatment because of the limited efficacy and side-effect potential of current pharmacological agents. This article summarizes the literature on non-pharmacological treatments for NPS in MCI. The limited number of studies specific to individuals with MCI and its various etiologies, as well as the overall heterogeneity of research design and methodologies, make the evidence base inconclusive. Nevertheless, some studies support psychosocial interventions aimed at individuals with MCI and their caregivers.
Keywords
mild cognitive impairment - neuropsychiatric symptoms - non-pharmacologic interventions - neuropsychiatry - behavioral neurologyPublikationsverlauf
Artikel online veröffentlicht:
04. März 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- 1 Prichard JC. A Treatise on Insanity and Other Disorders Affecting the Mind. Philadelphia: Haswell, Barrington, and Haswell; 1837
- 2 Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56 (03) 303-308
- 3 Petersen RC, Caracciolo B, Brayne C, Gauthier S, Jelic V, Fratiglioni L. Mild cognitive impairment: a concept in evolution. J Intern Med 2014; 275 (03) 214-228
- 4 Ritchie K, Artero S. Mild cognitive impairment (MCI): a historical perspective. In: Ames D, O'Brien J, Burns A. eds. Dementia. 5th ed.. Boca Raton: CRC Press; 2017: 419-425
- 5 Malek-Ahmadi M. Reversion from mild cognitive impairment to normal cognition: a meta-analysis. Alzheimer Dis Assoc Disord 2016; 30 (04) 324-330
- 6 Albert MS, DeKosky ST, Dickson D. et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011; 7 (03) 270-279
- 7 Maurer K, Volk S, Gerbaldo H. Auguste D and Alzheimer's disease. Lancet 1997; 349 (9064): 1546-1549
- 8 Donovan NJ, Amariglio RE, Zoller AS. et al. Subjective cognitive concerns and neuropsychiatric predictors of progression to the early clinical stages of Alzheimer disease. Am J Geriatr Psychiatry 2014; 22 (12) 1642-1651
- 9 Matsuoka T, Ismail Z, Narumoto J. Prevalence of mild behavioral impairment and risk of dementia in a psychiatric outpatient clinic. J Alzheimers Dis 2019; 70 (02) 505-513
- 10 Mallo SC, Valladares-Rodriguez S, Facal D, Lojo-Seoane C, Fernández-Iglesias MJ, Pereiro AX. Neuropsychiatric symptoms as predictors of conversion from MCI to dementia: a machine learning approach. Int Psychogeriatr 2020; 32 (03) 381-392
- 11 Wise EA, Rosenberg PB, Lyketsos CG, Leoutsakos JM. Time course of neuropsychiatric symptoms and cognitive diagnosis in National Alzheimer's Coordinating Centers volunteers. Alzheimers Dement (Amst) 2019; 11: 333-339
- 12 Ismail Z, Smith EE, Geda Y. et al; ISTAART Neuropsychiatric Symptoms Professional Interest Area. Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimers Dement 2016; 12 (02) 195-202
- 13 Kaufer DI, Cummings JL, Ketchel P. et al. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000; 12 (02) 233-239
- 14 Monastero R, Mangialasche F, Camarda C, Ercolani S, Camarda R. A systematic review of neuropsychiatric symptoms in mild cognitive impairment. J Alzheimers Dis 2009; 18 (01) 11-30
- 15 Martin E, Velayudhan L. Neuropsychiatric symptoms in mild cognitive impairment: a literature review. Dement Geriatr Cogn Disord 2020; 49 (02) 146-155
- 16 Pan Y, Shea Y-F, Li S. et al. Prevalence of mild behavioural impairment: a systematic review and meta-analysis. Psychogeriatrics 2021; 21 (01) 100-111
- 17 Mortby ME, Burns R, Eramudugolla R, Ismail Z, Anstey KJ. Neuropsychiatric symptoms and cognitive impairment: understanding the importance of co-morbid Symptoms. J Alzheimers Dis 2017; 59 (01) 141-153
- 18 Basta M, Simos P, Vgontzas A. et al. Associations between sleep duration and cognitive impairment in mild cognitive impairment. J Sleep Res 2019; 28 (06) e12864
- 19 Basta M, Zaganas I, Simos P. et al. Apolipoprotein E ɛ4 (APOE ɛ4) allele is associated with long sleep duration among elderly with cognitive impairment. J Alzheimers Dis 2021; 79 (02) 763-771
- 20 Yuen K, Rashidi-Ranjbar N, Verhoeff NPLG. et al; PACt-MD Study Group. Association between sleep disturbances and medial temporal lobe volume in older adults with mild cognitive impairment free of lifetime history of depression. J Alzheimers Dis 2019; 69 (02) 413-421
- 21 Naismith SL, Pye J, Terpening Z, Lewis S, Bartlett D. “Sleep Well, Think Well” group program for mild cognitive impairment: a randomized controlled pilot study. Behav Sleep Med 2019; 17 (06) 778-789
- 22 Leidi-Maimone B, Notter-Bielser M-L, Laouadi M-H. et al. How non-drug interventions affect the quality of life of patients suffering from progressive cognitive decline and their main caregiver. Aging (Albany NY) 2020; 12 (11) 10754-10771
- 23 Trivedi SC, Subramanyam AA, Pinto C, Gambhire DD. Neuropsychiatric symptoms in mild cognitive impairment: an analysis and its impact on caregiving. Indian J Psychiatry 2013; 55 (02) 154-160
- 24 Gilhooly KJ, Gilhooly MLM, Sullivan MP. et al. A meta-review of stress, coping and interventions in dementia and dementia caregiving. BMC Geriatr 2016; 16 (01) 106
- 25 Willment K, Altman A, Morrissey L, Searl M, Campbell L, Safar LT. Psychosocial interventions in neuropsychiatry. In: Silbersweig D, Safar LT, Daffner KR. eds. Neuropsychiatry and Behavioral Neurology: Principles and Practice. New York: McGraw-Hill; 2020: 271-289
- 26 Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev 2014; (01) CD009125
- 27 Reynolds GO, Willment K, Gale SA. Mindfulness and cognitive training interventions in mild cognitive impairment: impact on cognition and mood. Am J Med 2021; 134 (04) 444-455
- 28 Wells RE, Yeh GY, Kerr CE. et al. Meditation's impact on default mode network and hippocampus in mild cognitive impairment: a pilot study. Neurosci Lett 2013; 556: 15-19
- 29 Wilson RS, Schneider JA, Boyle PA, Arnold SE, Tang Y, Bennett DA. Chronic distress and incidence of mild cognitive impairment. Neurology 2007; 68 (24) 2085-2092
- 30 Chouinard A-M, Larouche E, Audet M-C, Hudon C, Goulet S. Mindfulness and psychoeducation to manage stress in amnestic mild cognitive impairment: a pilot study. Aging Ment Health 2019; 23 (09) 1246-1254
- 31 Klainin-Yobas P, Kowitlawakul Y, Lopez V. et al. The effects of mindfulness and health education programs on the emotional state and cognitive function of elderly individuals with mild cognitive impairment: a randomized controlled trial. J Clin Neurosci 2019; 68: 211-217
- 32 Kurz A, Pohl C, Ramsenthaler M, Sorg C. Cognitive rehabilitation in patients with mild cognitive impairment. Int J Geriatr Psychiatry 2009; 24 (02) 163-168
- 33 Bastawrous M. Caregiver burden—a critical discussion. Int J Nurs Stud 2013; 50 (03) 431-441
- 34 Isik AT, Soysal P, Solmi M, Veronese N. Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: a narrative review. Int J Geriatr Psychiatry 2019; 34 (09) 1326-1334
- 35 Cheng S-T. Dementia caregiver burden: a research update and critical analysis. Curr Psychiatry Rep 2017; 19 (09) 64
- 36 Bruce JM, McQuiggan M, Williams V, Westervelt H, Tremont G. Burden among spousal and child caregivers of patients with mild cognitive impairment. Dement Geriatr Cogn Disord 2008; 25 (04) 385-390
- 37 Poon E. A systematic review and meta-analysis of dyadic psychological interventions for BPSD, quality of life and/or caregiver burden in dementia or MCI. Clin Gerontol 2019; 22: 1-21
- 38 Joosten-Weyn Banningh LWA, Prins JB, Vernooij-Dassen MJFJ, Wijnen HH, Olde Rikkert MGM, Kessels RPC. Group therapy for patients with mild cognitive impairment and their significant others: results of a waiting-list controlled trial. Gerontology 2011; 57 (05) 444-454
- 39 Joosten-Weyn Banningh LWA, Roelofs SCF, Vernooij-Dassen MJFJ, Prins JB, Olde Rikkert MGM, Kessels RPC. Long-term effects of group therapy for patients with mild cognitive impairment and their significant others: a 6- to 8-month follow-up study. Dementia 2013; 12 (01) 81-91
- 40 Banningh LW, Vernooij-Dassen MJFJ, Vullings M, Prins JB, Rikkert MGMO, Kessels RPC. Learning to live with a loved one with mild cognitive impairment: effectiveness of a waiting list controlled trial of a group intervention on significant others' sense of competence and well-being. Am J Alzheimers Dis Other Demen 2013; 28 (03) 228-238
- 41 Domingues NS, Verreault P, Hudon C. Reducing burden for caregivers of older adults with mild cognitive impairment: a systematic review. Am J Alzheimers Dis Other Demen 2018; 33 (07) 401-414
- 42 Garand L, Morse JQ, ChiaRebecca L. et al. Problem-solving therapy reduces subjective burden levels in caregivers of family members with mild cognitive impairment or early-stage dementia: secondary analysis of a randomized clinical trial. Int J Geriatr Psychiatry 2019; 34 (07) 957-965
- 43 Yu DS-F, Li PW, Zhang F, Cheng S-T, Ng TK, Judge KS. The effects of a dyadic strength-based empowerment program on the health outcomes of people with mild cognitive impairment and their family caregivers: a randomized controlled trial. Clin Interv Aging 2019; 14: 1705-1717
- 44 Greenaway MC, Duncan NL, Smith GE. The memory support system for mild cognitive impairment: randomized trial of a cognitive rehabilitation intervention. Int J Geriatr Psychiatry 2013; 28 (04) 402-409
- 45 Akbaraly TN, Portet F, Fustinoni S. et al. Leisure activities and the risk of dementia in the elderly: results from the Three-City Study. Neurology 2009; 73 (11) 854-861
- 46 Aleixo MAR, Santos RL, do Nascimento Dourado MC. Efficacy of music therapy in the neuropsychiatric symptoms of dementia: systematic review. J Bras Psiquiatr 2017; 66 (01) 52-61
- 47 Masika GM, Yu DSF, Li PWC. Visual art therapy as a treatment option for cognitive decline among older adults. A systematic review and meta-analysis. J Adv Nurs 2020; (e-pub ahead of print)
- 48 Shimizu N, Umemura T, Matsunaga M, Hirai T. Effects of movement music therapy with a percussion instrument on physical and frontal lobe function in older adults with mild cognitive impairment: a randomized controlled trial. Aging Ment Health 2018; 22 (12) 1614-1626
- 49 Bolwerk A, Mack-Andrick J, Lang FR, Dörfler A, Maihöfner C. How art changes your brain: differential effects of visual art production and cognitive art evaluation on functional brain connectivity. PLoS One 2014; 9 (07) e101035
- 50 Pongan E, Tillmann B, Leveque Y. et al; LACMé Group. Can musical or painting interventions improve chronic pain, mood, quality of life, and cognition in patients with mild alzheimer's disease? Evidence from a randomized controlled trial. J Alzheimers Dis 2017; 60 (02) 663-677
- 51 Mahendran R, Gandhi M, Moorakonda RB. et al. Art therapy is associated with sustained improvement in cognitive function in the elderly with mild neurocognitive disorder: findings from a pilot randomized controlled trial for art therapy and music reminiscence activity versus usual care. Trials 2018; 19 (01) 615
- 52 Woods B, O'Philbin L, Farrell EM, Spector AE, Orrell M. Reminiscence therapy for dementia. Cochrane Database Syst Rev 2018; 3: CD001120
- 53 Nakamura K, Kasai M, Nakai M, Nakatsuka M, Meguro K. The Group reminiscence approach can increase self-awareness of memory deficits and evoke a life review in people with mild cognitive impairment: the Kurihara project data. J Am Med Dir Assoc 2016; 17 (06) 501-507
- 54 Rose N, Whitworth A, Smart S, Oliver E, Cartwright J. “I remember when … ”: The impact of reminiscence therapy on discourse production in older adults with cognitive impairment. Int J Speech Lang Pathol 2020; 22 (03) 359-371
- 55 Hu M, Zhang P, Leng M, Li C, Chen L. Animal-assisted intervention for individuals with cognitive impairment: a meta-analysis of randomized controlled trials and quasi-randomized controlled trials. Psychiatry Res 2018; 260: 418-427
- 56 Peluso S, De Rosa A, De Lucia N. et al. Animal-assisted therapy in elderly patients: evidence and controversies in dementia and psychiatric disorders and future perspectives in other neurological diseases. J Geriatr Psychiatry Neurol 2018; 31 (03) 149-157
- 57 Bono AV, Benvenuti C, Buzzi M. et al. Effects of animal assisted therapy (AAT) carried out with dogs on the evolution of mild cognitive impairment. G Gerontol 2015; 63 (01) 32-36
- 58 Opdebeeck C, Katsaris MA, Martyr A. et al. What are the benefits of pet ownership and care among people with mild-to-moderate dementia? Findings from the IDEAL programme. J Appl Gerontol 2021; 40 (11) 1559-1567
- 59 Jøranson N, Pedersen I, Rokstad AMM, Ihlebæk C. Effects on symptoms of agitation and depression in persons with dementia participating in robot-assisted activity: a cluster-randomized controlled trial. J Am Med Dir Assoc 2015; 16 (10) 867-873
- 60 Gates N, Valenzuela M. Cognitive exercise and its role in cognitive function in older adults. Curr Psychiatry Rep 2010; 12 (01) 20-27
- 61 Ge S, Zhu Z, Wu B, McConnell ES. Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review. BMC Geriatr 2018; 18 (01) 213
- 62 Faucounau V, Wu Y-H, Boulay M, De Rotrou J, Rigaud A-S. Cognitive intervention programmes on patients affected by Mild Cognitive Impairment: a promising intervention tool for MCI?. J Nutr Health Aging 2010; 14 (01) 31-35
- 63 Rozzini L, Costardi D, Chilovi BV, Franzoni S, Trabucchi M, Padovani A. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. Int J Geriatr Psychiatry 2007; 22 (04) 356-360
- 64 Bahar-Fuchs A, Webb S, Bartsch L. et al. Tailored and adaptive computerized cognitive training in older adults at risk for dementia: a randomized controlled trial. J Alzheimers Dis 2017; 60 (03) 889-911
- 65 Cipriani G, Bianchetti A, Trabucchi M. Outcomes of a 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 (03) 327-335
- 66 Finn M, McDonald S. Computerised cognitive training for older persons with mild cognitive impairment: a pilot study using a randomised controlled trial design. Brain Impair 2011; 12 (03) 187-199
- 67 Belleville S, Hudon C, Bier N. et al. MEMO+: efficacy, durability and effect of cognitive training and psychosocial intervention in individuals with mild cognitive impairment. J Am Geriatr Soc 2018; 66 (04) 655-663
- 68 Gooding AL, Choi J, Fiszdon JM. et al. Comparing three methods of computerised cognitive training for older adults with subclinical cognitive decline. Neuropsychol Rehabil 2016; 26 (5-6): 810-821
- 69 Barnes DE, Yaffe K, Belfor N. et al. Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial. Alzheimer Dis Assoc Disord 2009; 23 (03) 205-210
- 70
Ashdown-Franks G,
Firth J,
Carney R.
et al.
Exercise as medicine for mental and substance use disorders: a meta-review of the
benefits for neuropsychiatric and cognitive outcomes. Sports Med 2020; 50 (01) 151-170
MissingFormLabel
- 71 Blake H, Mo P, Malik S, Thomas S. How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clin Rehabil 2009; 23 (10) 873-887
- 72 Rabin JS, Klein H, Kirn DR. et al. Associations of physical activity and β-amyloid with longitudinal cognition and neurodegeneration in clinically normal older adults. JAMA Neurol 2019; 76 (10) 1203-1210
- 73 Almeida OP, Khan KM, Hankey GJ, Yeap BB, Golledge J, Flicker L. 150 minutes of vigorous physical activity per week predicts survival and successful ageing: a population-based 11-year longitudinal study of 12 201 older Australian men. Br J Sports Med 2014; 48 (03) 220-225
- 74
Krivanek TJ,
Gale SA,
McFeeley BM,
Nicastri CM,
Daffner KR.
Promoting successful cognitive aging: a ten-year update. J Alzheimers Dis 2021; 81
(03) 871-920
MissingFormLabel
- 75 ten Brinke LF, Bolandzadeh N, Nagamatsu LS. et al. Aerobic exercise increases hippocampal volume in older women with probable mild cognitive impairment: a 6-month randomised controlled trial. Br J Sports Med 2015; 49 (04) 248-254
- 76 Demurtas J, Schoene D, Torbahn G. et al; European Society of Geriatric Medicine Special Interest Group in Systematic Reviews and Meta-Analyses, Frailty, Sarcopenia, and Dementia. Physical activity and exercise in mild cognitive impairment and dementia: an umbrella review of intervention and observational studies. J Am Med Dir Assoc 2020; 21 (10) 1415-1422.e6
- 77 Lam LCW, Chau RCM, Wong BML. et al. A 1-year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline. J Am Med Dir Assoc 2012; 13 (06) 568.e15-568.e20
- 78 Wang L, Wu B, Tao H. et al. Effects and mediating mechanisms of a structured limbs-exercise program on general cognitive function in older adults with mild cognitive impairment: a randomized controlled trial. Int J Nurs Stud 2020; 110: 103706
- 79 Sungkarat S, Boripuntakul S, Chattipakorn N, Watcharasaksilp K, Lord SR. Effects of Tai Chi on cognition and fall risk in older adults with mild cognitive impairment: a randomized controlled trial. J Am Geriatr Soc 2017; 65 (04) 721-727
- 80 Cho J, Martin P, Margrett J, Macdonald M, Poon LW. The relationship between physical health and psychological well-being among oldest-old adults. J Aging Res 2011; 2011: 605041
- 81 Darviri C, Zavitsanou C, Delikou A. et al. A novel non-pharmaceutical treatment for patients with mild cognitive impairment. Psychology (Irvine) 2016; 7 (05) 678-686
- 82 Buschert VC, Friese U, Teipel SJ. et al. Effects of a newly developed cognitive intervention in amnestic mild cognitive impairment and mild Alzheimer's disease: a pilot study. J Alzheimers Dis 2011; 25 (04) 679-694
- 83 Cintoli S, Radicchi C, Noale M. et al; Train the Brain Consortium. Effects of combined training on neuropsychiatric symptoms and quality of life in patients with cognitive decline. Aging Clin Exp Res 2021; 33 (05) 1249-1257
- 84 Kurz A, Thöne-Otto A, Cramer B. et al. CORDIAL: cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease: a multicenter, randomized, controlled trial. Alzheimer Dis Assoc Disord 2012; 26 (03) 246-253
- 85 Tonga JB, Šaltytė Benth J, Arnevik EA, Werheid K, Korsnes MS, Ulstein ID. Managing depressive symptoms in people with mild cognitive impairment and mild dementia with a multicomponent psychotherapy intervention: a randomized controlled trial. Int Psychogeriatr 2021; 33 (03) 217-231
- 86 Fitzgerald PB, Hoy KE, Anderson RJ, Daskalakis ZJ. A study of the pattern of response to rTMS treatment in depression. Depress Anxiety 2016; 33 (08) 746-753
- 87 Holczer A, Németh VL, Vékony T, Vécsei L, Klivényi P, Must A. Non-invasive brain stimulation in Alzheimer's disease and mild cognitive impairment-a state-of-the-art review on methodological characteristics and stimulation parameters. Front Hum Neurosci 2020; 14: 179
- 88 Faulkner SM, Bee PE, Meyer N, Dijk D-J, Drake RJ. Light therapies to improve sleep in intrinsic circadian rhythm sleep disorders and neuro-psychiatric illness: a systematic review and meta-analysis. Sleep Med Rev 2019; 46: 108-123
- 89 Abraha I, Rimland JM, Trotta FM. et al. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open 2017; 7 (03) e012759
- 90 Khachiyants N, Trinkle D, Son SJ, Kim KY. Sundown syndrome in persons with dementia: an update. Psychiatry Investig 2011; 8 (04) 275-287
- 91 Wennberg AMV, Wu MN, Rosenberg PB, Spira AP. Sleep disturbance, cognitive decline, and dementia: a review. Semin Neurol 2017; 37 (04) 395-406
- 92 Chiu HL, Chan P-T, Chu H. et al. Effectiveness of light therapy in cognitively impaired persons: a metaanalysis of randomized controlled trials. J Am Geriatr Soc 2017; 65 (10) 2227-2234
- 93 Falck RS, Davis JC, Best JR. et al. Effect of a multimodal lifestyle intervention on sleep and cognitive function in older adults with probable mild cognitive impairment and poor sleep: a randomized clinical trial. J Alzheimers Dis 2020; 76 (01) 179-193
- 94 Kouzuki M, Kitao S, Kaju T, Urakami K. Evaluation of the effect of aroma oil as a bath salt on cognitive function. Psychogeriatrics 2020; 20 (02) 163-171
- 95 Ball EL, Owen-Booth B, Gray A, Shenkin SD, Hewitt J, McCleery J. Aromatherapy for dementia. Cochrane Database Syst Rev 2020; 8: CD003150
- 96 Lara E, Martín-María N, De la Torre-Luque A. et al. Does loneliness contribute to mild cognitive impairment and dementia? A systematic review and meta-analysis of longitudinal studies. Ageing Res Rev 2019; 52: 7-16
- 97 “Internet/Broadband Fact Sheet”. Pew Center Research. Washington, D.C. April 7, 2021 URL: https://www.pewresearch.org/internet/fact-sheet/internet-broadband/
- 98 “Mobile Fact Sheet”. Pew Center Research. Washington, D.C. April 7, 2021 URL: https://www.pewresearch.org/internet/fact-sheet/mobile/
- 99 Wolfe MK, McDonald NC, Holmes GM. Transportation barriers to health care in the United States: findings from the national health interview survey, 1997–2017. Am J Public Health 2020; 110 (06) 815-822
- 100 Apostolova LG, Di LJ, Duffy EL. et al. Risk factors for behavioral abnormalities in mild cognitive impairment and mild Alzheimer's disease. Dement Geriatr Cogn Disord 2014; 37 (5-6): 315-326
- 101 Lee HB, Richardson AK, Black BS, Shore AD, Kasper JD, Rabins PV. Race and cognitive decline among community-dwelling elders with mild cognitive impairment: findings from the Memory and Medical Care Study. Aging Ment Health 2012; 16 (03) 372-377
- 102 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.. Washington D.C.: American Psychiatric Association; 2013