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      Mild cognitive impairment and progression to dementia of Alzheimer's disease Translated title: Comprometimento cognitivo leve e progressão para a demência da doença de Alzheimer

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          Abstract

          Summary The increase in life expectancy in the Brazilian population raises questions about the preparation of the public health system in identifying elderly patients with signs of cognitive impairment. Currently, as a consequence of the long duration of preclinical phase of Alzheimer's disease, efforts of early detection have been emphasized. Clinical dementia presents an important impact on the individual's caregivers, family, society and economy. Identifying individuals who already have some cognitive impairment, despite remaining functional, as well as analyzing associated comorbidities, constitutes an opportunity to analyze possibilities for future interventions. Dementias are clinical conditions that impose a burden on the health system with its high costs, whereas the identification of individuals with cognitive impairment without dementia can aid patients and their families to plan the future and mitigate costs. This narrative revision can provide general practitioners with more information on the subject.

          Translated abstract

          Resumo O aumento da expectativa de vida da população brasileira faz surgir questões sobre o preparo do sistema de saúde pública na identificação de pacientes idosos com sinais de alteração cognitiva. Atualmente, como consequência da longa duração da fase pré-clínica da doença de Alzheimer (DA), existe maior ênfase sobre a detecção precoce. A demência apresenta um importante impacto sobre a família, os cuidadores, a sociedade e a economia. Identificar indivíduos que já apresentam algum comprometimento cognitivo, embora eles mantenham a funcionalidade, bem como analisar as comorbidades associadas constituem oportunidades para direcionar futuras intervenções. Demências são doenças que impõem sobrecarga ao sistema público de saúde, com altos custos. A identificação de indivíduos com alteração cognitiva sem demência pode adicionar planejamentos futuros por parte do próprio doente, da sua família e dos cuidadores, resultando em menor sobrecarga física e emocional para todos os envolvidos. Esta revisão narrativa tem como objetivo ajudar os clínicos gerais a atuar na detecção dos idosos que se encontram em risco de desenvolver demência.

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          Most cited references33

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          Vitamin E and donepezil for the treatment of mild cognitive impairment.

          Mild cognitive impairment is a transitional state between the cognitive changes of normal aging and early Alzheimer's disease. In a double-blind study, we evaluated subjects with the amnestic subtype of mild cognitive impairment. Subjects were randomly assigned to receive 2000 IU of vitamin E daily, 10 mg of donepezil daily, or placebo for three years. The primary outcome was clinically possible or probable Alzheimer's disease; secondary outcomes were cognition and function. A total of 769 subjects were enrolled, and possible or probable Alzheimer's disease developed in 212. The overall rate of progression from mild cognitive impairment to Alzheimer's disease was 16 percent per year. As compared with the placebo group, there were no significant differences in the probability of progression to Alzheimer's disease in the vitamin E group (hazard ratio, 1.02; 95 percent confidence interval, 0.74 to 1.41; P=0.91) or the donepezil group (hazard ratio, 0.80; 95 percent confidence interval, 0.57 to 1.13; P=0.42) during the three years of treatment. Prespecified analyses of the treatment effects at 6-month intervals showed that as compared with the placebo group, the donepezil group had a reduced likelihood of progression to Alzheimer's disease during the first 12 months of the study (P=0.04), a finding supported by the secondary outcome measures. Among carriers of one or more apolipoprotein E epsilon4 alleles, the benefit of donepezil was evident throughout the three-year follow-up. There were no significant differences in the rate of progression to Alzheimer's disease between the vitamin E and placebo groups at any point, either among all patients or among apolipoprotein E epsilon4 carriers. Vitamin E had no benefit in patients with mild cognitive impairment. Although donepezil therapy was associated with a lower rate of progression to Alzheimer's disease during the first 12 months of treatment, the rate of progression to Alzheimer's disease after three years was not lower among patients treated with donepezil than among those given placebo. Copyright 2005 Massachusetts Medical Society.
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            Natural history of mild cognitive impairment in older persons.

            Cognitive abilities of older persons range from normal, to mild cognitive impairment, to dementia. Few large longitudinal studies have compared the natural history of mild cognitive impairment with similar persons without cognitive impairment. Participants were older Catholic clergy without dementia, 211 with mild cognitive impairment and 587 without cognitive impairment, who underwent annual clinical evaluation for AD and an assessment of different cognitive abilities. Cognitive performance tests were summarized to yield a composite measure of global cognitive function and separate summary measures of episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability. The authors compared the risk of death, risk of incident AD, and rates of change in global cognition and different cognitive domains among persons with mild cognitive impairment to those without cognitive impairment. All models controlled for age, sex, and education. On average, persons with mild cognitive impairment had significantly lower scores at baseline in all cognitive domains. Over an average of 4.5 years of follow-up, 30% of persons with mild cognitive impairment died, a rate 1.7 times higher than those without cognitive impairment (95% CI, 1.2 to 2.5). In addition, 64 (34%) persons with mild cognitive impairment developed AD, a rate 3.1 times higher than those without cognitive impairment (95% CI, 2.1 to 4.5). Finally, persons with mild cognitive impairment declined significantly faster on measures of episodic memory, semantic memory, and perceptual speed, but not on measures of working memory or visuospatial ability, as compared with persons without cognitive impairment. Mild cognitive impairment is associated with an increased risk of death and incident AD, and a greater rate of decline in selected cognitive abilities.
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              Treatment for mild cognitive impairment: systematic review.

              More people are presenting with mild cognitive impairment (MCI), frequently a precursor to dementia, but we do not know how to reduce deterioration. To systematically review randomised controlled trials (RCTs) evaluating the effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality or incident dementia. We reviewed 41 studies fitting predetermined criteria, assessed validity using a checklist, calculated standardised outcomes and prioritised primary outcome findings in placebo-controlled studies. The strongest evidence was that cholinesterase inhibitors did not reduce incident dementia. Cognition improved in single trials of: a heterogeneous psychological group intervention over 6 months; piribedil, a dopamine agonist over 3 months; and donepezil over 48 weeks. Nicotine improved attention over 6 months. There was equivocal evidence that Huannao Yicong improved cognition and social functioning. There was no replicated evidence that any intervention was effective. Cholinesterase inhibitors and rofecoxib are ineffective in preventing dementia. Further good-quality RCTs are needed and preliminary evidence suggests these should include trials of psychological group interventions and piribedil.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ramb
                Revista da Associação Médica Brasileira
                Rev. Assoc. Med. Bras.
                Associação Médica Brasileira (São Paulo, SP, Brazil )
                0104-4230
                1806-9282
                July 2017
                : 63
                : 7
                : 651-655
                Affiliations
                [4] São Paulo orgnameUniversidade Federal de São Paulo Brazil
                [1] São Paulo orgnameUniversidade Federal de São Paulo orgdiv1Escola Paulista de Medicina orgdiv2Psychiatry Department Brazil
                [2] Botucatu São Paulo orgnameUniversidade Estadual Paulista Júlio de Mesquita Filho orgdiv1Faculdade de Medicina de Botucatu orgdiv2Department of Internal Medicine Brazil
                [6] orgnameHospital Santa Marcelina Brazil
                [3] Botucatu São Paulo orgnameUniversidade Estadual Paulista Júlio de Mesquita Filho orgdiv1FMB Brazil
                [5] São Paulo orgnameUniversidade Federal de São Paulo orgdiv1EPM orgdiv2Psychiatry Department Brazil
                Article
                S0104-42302017000700651
                10.1590/1806-9282.63.07.651
                7deb2a03-5248-4294-b304-b58eaed21d7c

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 15 January 2017
                : 05 February 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 43, Pages: 5
                Product

                SciELO Brazil


                elderly,cognitive deficits,mild cognitive impairment,general practice,Alzheimer's disease,diagnosis,idoso,déficit cognitivo,comprometimento cognitivo leve,clínico geral,doença de Alzheimer,diagnóstico

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