Mild cognitive impairment denotes abnormal cognitive decline
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
I actually got this one right.
MKSAP – Memory Loss in an 81 Year Old Male
Neurology
More Bacon Please
Red meat consumption and risk of stroke in Swedish men
Conclusion: The findings from this prospective cohort of men indicate that processed meat consumption is positively associated with risk of stroke. The Cohort of Swedish Men is registered at clinicaltrials.gov as NCT01127711.
I just bought a package of bacon today. Then I read this abstract. The perfect definition of a quandary.
Spot the Lesion
Spot the Lesion – MedPage Today Blogs – 27989
While the NEJM Image Challenge is challenging, the blog I’ve linked to is much more informative and educational. Click the first link for the patient pictures and problem description. The second link provides the answer and the physician’s deductive reasoning.
This post is dedicated to the medical student in my life who starts his Neurology block later this year.
NEJM Teaching Topic – MCI
The NEJM Resident e-Bulletin is one of the ways I keep up with medical information. While it will not be possible for me to reproduce every email that comes from this service, on occasion I will post topics of interest. Copyright remains vested with the NEJM so don’t try and steal this to make money.
Teaching Topic
Mild Cognitive Impairment
Clinical Practice
Mild Cognitive Impairment
R.C. Petersen
MCI represents an intermediate state of cognitive function between the changes seen in aging and those fulfilling criteria for dementia, often Alzheimer’s disease (AD).
Clinical Pearls
What is the estimated prevalence of MCI?
The estimated prevalence of MCI in population-based studies ranges from 10 to 20%. In the Mayo Clinic Study of Aging, a prospective, population-based study of non-demented persons ages 70 to 89 years at enrollment, the prevalence of amnestic MCI was 11.1% and of nonamnestic MCI, 4.9%.
How can the “worried well” be differentiated from patients with MCI?
Neuropsychological testing may be necessary to corroborate a history of decline in cognition, usually memory. At times, the “worried well” can give a convincing history for memory loss, but neuropsychological testing reveals normal performance.
Figure 1. Diagnostic Algorithm for Amnestic and Nonamnestic Mild Cognitive Impairment.
Morning Report Questions
Q. What factors predict a more rapid progression of cognitive impairment among patients with MCI?
A. As compared with the incidence rate for dementia in the general population of 1 to 2% per year, the incidence of dementia in patients with MCI is significantly increased, with an annual rate of 5 to 10% in community-based populations and 10 to 15% in clinic-based populations. The degree of cognitive impairment at presentation is a clinical predictor of progression; those with greater baseline impairment appear more likely to progress more rapidly. The presence of the apolipoprotein E ε4 allele is also predictive of progression rate. Several MRI measures have also been reported to predict a faster rate of progression, including atrophic hippocampi, dilated ventricles, reduced total brain volume, and the presence of white matter hyperintensities.
Q. How can patients with MCI be managed?
A. Limited data support the potential benefit of cognitive rehabilitation approaches. Several clinical trials that treated persons with MCI with cholinesterase inhibitors used for AD (donepezil, galantamine, and rivastigmine) at standard AD treatment doses for 2 to 4 years have shown no significant reduction in the rates of progression to dementia.
More EVO = Lower Stroke Risk
Medical News: Olive Oil Protects Against Stroke – in Neurology, Strokes from MedPage Today
Observational study on French people.
I wonder if the researchers controlled for red wine consumption.
More on Multitasking – 04/23/2001
Interviews – Clifford Nass | Digital Nation | FRONTLINE | PBS
“It turns out multitaskers are terrible at every aspect of multitasking. They’re terrible at ignoring irrelevant information; they’re terrible at keeping information in their head nicely and neatly organized; and they’re terrible at switching from one task to another.”
This interview is worth reading in its entirety.
Namenda in the News
Be Still…(it may help your brain)
Mindfulness Meditation Is Associated With Structural Changes in the Brain [NCCAM Research Results]
Brain images in the meditation group revealed increases in gray matter concentration in the left hippocampus. The hippocampus is an area of the brain involved in learning, memory, and emotional control, and is suspected of playing a role in producing some of the positive effects of meditation. Gray matter also increased in four other brain regions (though not in the insula, a region that has shown changes in other meditation studies) in the meditation group. Responses to the questionnaire indicated improvements in three of the five aspects of mindfulness in the mediators, but not the control group.
The researchers concluded that these findings may represent an underlying brain mechanism associated with mindfulness-based improvements in mental health. Additional studies are needed to determine the associations between specific types of brain change and behavioral mechanisms thought to improve a variety of disorders.
More Statin Stuff 01/11/11
Memantine for PDD or DLB
Underwriting Quick Notes:
- PDD = Parkinson’s Disease Dementia
- DLB = Dementia with Lewy Bodies
- Memantine = Namenda
Memantine seems to improve global clinical status and behavioural symptoms of patients with mild to moderate DLB, and might be an option for treatment of these patients.
lifeunderwriter.net 
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