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Mild Cognitive Impairment

Penelitian : Mild Cognitive Impairment


Petersen, et. al., 1999
Arch Neurol Volum 54 hal. 303

Complaint of forgetfulness
Is it normal?
Is it dementia?
Is it AD?

MCI?

Masa Kini terfokus pada;


Kemunduran Fungsi Kognitif Pada Lanjut
Usia
MCI sebagai fase transisi penyakit
Alzheimer

Bagaimana mengenali;
Kelompok Lanjut Usia dengan Kemunduran
Kognitif:
Masih Normal
Sudah Patologis

Model Alzheimers Disease


Katzman (1993)
Latent Phase
Maglinant Phase:
1. Pre-clinical Phase
2. Clinical Symptom Appear
3. Diagnosis
4. Loses Independence
5. Death

Continuum (Rangkaian
Kesatuan)
Benign Senescent Forgetfulness (BSF) atau
Age Associated Memory Impairment
(AAMI)
Mild Cognitive Impairment (MCI)
Alzheimer Disease (AD)

Mild Cognitive Impairment (MCI)


Mild cognitive impairment (MCI) represents a stage of cognitive
impairment that exceeds the normal expected age-related
changes, but functional activities are largely preserved and so
MCI does not meet the criteria for dementia.
To demonstrate that cognitive function is worse than expected
for age, neuropsychological testing is necessary so that a
patients performance can be compared with that of an agematched (and ideally education-matched) control group.
MCI is heterogeneous both in its clinical manifestations and in
its etiology. There's no single cause of MCI, just as there's no
single outcome for the disorder.

Mild Cognitive Impairment (MCI)


Prevalence in population-based epidemiological
studies ranges from 3% to 19% in adults older than
65 years.
Some people with MCI seem to remain stable or
return to normal over time, but more than half
progress to Alzheimer's disease or another type of
dementia within 5 years.
MCI can thus be regarded as a risk state for
dementia, and its identification could lead to
secondary prevention by controlling risk factors
such as systolic hypertension.

MCI studies
Study

Subjects
(no.)

Age

MCI prevalence
(%)

Kungsholmen

379

75 - 95

11.1

Leipzig

980

75

19.2

ADAMS

856

71

22.1

Manhatten

2.364

65

26.9

CHS

2.470

75

19

Vienna

697

75

24

Finland

806

60 - 75

5.3

Italy

2.830

65 85

16.1

Indianapolis

2.212

65

23.4

MoVIES

1.248

65

3.5

India

745 (960)

50

14.9

Mayo

1.969

70 89

14.0

Adapted from : Golomb J, Kluger A, Garrard P, Ferris S.

Towards a Broader Concept of


MCI
Considering heterogeneity of MCI
stable age-appropriate
memory impairment

Normative
Aging
Aging

MCI

Dementia
Dementia

incipient
dementia
prodromal
AD

reversible cognitive
impairment (i.e. confusion)

prodromal VaD
prodromal mixed

physical illness
depression

AD/VaD
prodromal DLBD
prodromal FLD

Antisipasi MCI menjadi AD


Pekerjaan
Keuangan dan Legalitas
Peranan Kesehatan

Kelompok Perantara = In
between Group
I. Kelompok : Preclinical Dementia
II. Kelompok Predementia

Kelompok I
AAMI (Age Associated Memory
Impairment) 1986
ARCD (Age Related Cognitive Decline)
1994
AACD (Age Associated Cognitive Decline)
1994

Kelompok II
MCD (Mild Cognitive Disorder) 1992
MND (Mild Neurocognitive Disorder) 1994
CIND (Cognitively Impaired Not
Demented)1995
MCI (Mild Cognitive Impairment) 1999

Criteria MCI (World Alzheimer


Congress):
Person with Memory Impairment beyond
would be Expected for Age
Yet They are not Demented
General Cognitive Function and ADL relatif
Normal
Significantly Impaired: Learning and Delayed
Recall
Clinical Dementia Rating (CDR) 0,5

Hasil Penelitian Pettersen:


Learning and Delayed Recall Lebih terganggu
daripada Kontrol; Kurang dari pada AD
Rasio Konversi menjadi AD : 12%/tahun
dibanding Normal 1-2%
MMSE pada MCI sama dibanding Kontrol
Global Deterioration Scale (GDS) lebih
lambat dibanding AD

Prevalensi Beragam
6,5 % (Finland)
18 - 35% (Bullock)
17% (Cooper & Bickel)

Perbedaan MCI dan BSF/AAMI


BSF/AAMI;
Mudah Lupa Sementara
Masih Ingat Informasi Bermakna
Subjektif
MCI;
Mudah Lupa terus menerus
Sulit Ingat Fakta dalam Waktu Pendek
Lupa Informasi yang bermakna
Subjektif dan Objektif

Hubungan MCI dan AD


MCI;
Terurtama gangguan memory
Dapat Memburuk atau menetap
ADL Normal, IADL dapat Terganggu
AD;
Gangguan Memory dan Fungsi Lain (Orientasi, Bahasa,
Atensi)
Memburuk Secara Progresif
ADL dan IADL terganggu