COMMENTARY

Use It or Lose It to Prevent Alzheimer Disease

Peter M. Yellowlees, MBBS, MD

Disclosures

April 26, 2018

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

The assessment, treatment, and counseling of patients with possible mild cognitive impairment (MCI) has long been difficult and uncertain. Now a team of investigators[1] from the Mayo Clinic, Minnesota, have updated the 2001 American Academy of Neurology (AAN) guideline on MCI by systematically reviewing MCI prevalence, prognosis, and treatment articles according to AAN evidence classification criteria.

The investigators concluded that MCI prevalence was 6.7% (60-64 years), 8.4% (65-69 years), 10.1% (70-74 years), 14.8% (75-79 years), and 25.2% (80-84 years). They also found a cumulative dementia incidence of 14.9% in individuals with MCI older than age 65 years followed for 2 years and that no high-quality evidence exists to support pharmacologic treatments for MCI. They concluded, among other clinical recommendations, that in patients with MCI, exercise training is likely to improve cognitive measures and cognitive training may also be helpful.

These findings are important. Firstly, they give us some solid prevalence numbers for MCI to discuss with patients and their families, although there is still no good sensitive cognitive screening measure available to differentiate between MCI and dementia, given the 15% two-year progression to dementia. Secondly, the lack of value of cholinesterase inhibitors and the positive impact of exercise, and possibly cognitive training, are key clinical recommendations we can use to help patients and their families help themselves. It seems that the old adage that you must "use it or lose it" is especially true for patients with MCI.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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