This text-based course is a transcript of the event, “Treatment of MCI: What the SLP needs to know”, presented by Kimberly McCullough, Ph.D., CCC-SLP.
>> Kim McCullough: We are going to talk about treatment of Mild Cognitive Impairment, or MCI. Before we get started, for those of you who are new to this and do not know a lot about MCI, we are going to define it and then talk about assessment. Then we will talk about treatment of MCI and look at some of the evidence that points in the direction we need to go for developing treatment protocols and knowing what works and what evidence supports what we might do.
MCI is a transitional zone between normal cognition and dementia. It is well documented that in most people, as we age, there are changes in cognition. Not everyone will develop MCI, but some people certainly will. Those people who are diagnosed with MCI do not necessarily develop dementia. We do need to be aware that although 60% of the people who present with MCI will not develop dementia, 40% of those who have the diagnosis of MCI will. That is certainly quite a large population to think about, because MCI does affect approximately 20% of the population over the age of 70. We are certainly aware of the ever-increasing number of baby boomers and the explosion of the population of individuals over the age of 70. This will be quite a substantial clinical group that we will need to be aware of.
How do we define MCI? In 2011, there was a working group that got together with individuals from the National Institute on Aging as well as from the Alzheimer's Association, and based on all of their clinical data, they came up with the new and revised definition. This definition states that for the person to be diagnosed with MCI, the individual has to report a concern regarding some type of change in cognition. That concern can be raised by the patients themselves. It can also, according to the definition, be reported by someone who knows the patient well or even by an examining clinician that is looking at their cognitive functioning. There has to be this concern regarding the change.
The next characteristic or feature of the diagnosis includes impairment in one or more cognitive domains. The key to this is that you have to have some type of impairment in either memory, language, executive functioning, or visual spatial skills, and you have to score anywhere from 1 to 1.5 standard deviations below the mean. We will look at some examples as we go through this presentation about what some of those different numbers might look like. That is not a lot of deviation from the mean. Sometimes it is very difficult to determine whether or not someone has mild cognitive impairment, or whether or not you are seeing normal aging. Certainly, clinical skill comes into play here. They are going to have a concern, they are going to have an impairment in one or more of these cognitive domains, but they are also going to be independent in all functional abilities, and they do not have dementia. This population of individuals may still be people who work, who are very actively involved in either work or their community and have not seen a change that is great enough to cause them to not participate in activities, but enough of a change that they do have some awareness or concern.
When we look at the different types of clinical presentations in regards to MCI, there are several different types that you need to be aware of. The first is MCI of the single domain. Typically you will see it with memory impairments and in combination with the “MCI amnestic,” which would indicate just memory impairments. Then you will have individuals who have MCI in multiple domains, including language, executive functioning, and visual spatial skills. Then there will be a subcategory of patients who do not have memory impairments, but present with impairments in the other areas including language, executive functioning, and visual spatial skills.
There are many possible etiologies associated with MCI. Certainly it could be degenerative in nature, and these include Alzheimer's dementia, which is the most commonly occurring disease process. In addition to that, you have Lewy Body disease, Parkinson's disease, frontotemporal dementia, and also vascular types of impairments. You have cerebrovascular disease that can also result in dementia, and other metabolic, traumatic, and psychiatric types of disorders that may cause concern for or may present as cognitive impairments.
Below is a flowchart that is commonly seen in presentations because it is so helpful in trying to determine what types of patterns of impairment your patient is presenting with. Basically, this flowchart restates what was discussed previously and gives you some information about how to make decisions regarding what type of impairment your patient is presenting.