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Cognitive Impairments Beyond Memory Loss Could Signal Dementia

Dementia risk increases significantly in elderly patients who have clear cognitive impairments beyond memory loss.

"Among non-demented elderly patients, memory loss alone rarely progresses to dementia in the subsequent two years," North American researchers explain.

"However, the risk of dementia is significantly increased among patients with clear cognitive impairments beyond memory loss."

Many older adults complain of memory loss, the researchers point out. Some show demonstrable memory impairment.

Prognosis varies for patients with memory impairment who have preserved general intellect and activities of daily living. "In some cases, this pattern of cognitive deficits may indicate the earliest symptoms of dementia. Others will have a more benign course," they note.

University of Michigan Medical Centre and Veterans Affairs Medical Centre researchers in Ann Arbor, United States conducted a retrospective study of 48 patients with a mean age of 69.4 years.

Participants were non-demented, non-depressed patients who had demonstrated clinical and psychometric evidence of memory impairment. All were followed for a mean of 3.5 years.

Of the 48 patients, 31 were impaired in one or more of four cognitive areas -- language, attention, motor visuospatial function and verbal fluency. At two-year's follow-up, 15 of these patients (48 percent) had progressed to Alzheimer disease.

Of the 17 patients without an additional cognitive impairment, only one (6 percent) progressed to Alzheimer in the two-year period.

"One of the goals of a clinical neurologist is to predict which mildly impaired individuals will develop a clear dementia," the researchers comment.

"Improving our ability to predict the appearance of dementia at an earlier stage and with greater accuracy could not only reassure many, but could also spare patients and their families the heightened anxiety that accompanies years of watchful waiting."

Investigators suggest that early diagnosis would allow specific, early application of interventions targeted at secondary prevention.

"Medications currently considered too toxic or risky to be given to the very broad category of people -- older than 60 years with reduced memory efficiency -- might be used if the population to be treated was deemed to be more clearly at risk.

"Because of its significant emotional and financial implications, until reliable criteria are established, Alzheimer disease should only be diagnosed when dementia is clearly present."
Archives of Neurology, 2001; 58: 411-416. "Mild Cognitive Impairments Predict Dementia in Nondemented Elderly Patients With Memory Loss"

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