Recognizing Cognitive Impairment and Slowing Symptom Progression

Subjective cognitive impairment (SCI) does not appear anywhere in the DSM-5, but biomarkers and clinical features enable providers to identify the condition in patients, George T. Grossberg, MD, told Psych Congress attendees Sunday.

SCI is a potential early indicator of mild cognitive impairment, which is a prodrome to Alzheimer’s disease.

“Amyloid and tau biomarker profiles become increasingly abnormal from SCI to mild cognitive impairment to Alzheimer’s disease,” explained Dr. Grossberg, Director of the Geriatric Psychiatry Division at the St. Louis University School of Medicine in Missouri. “Amyloid and tau biomarkers are unable to differentiate between SCI and healthy controls but may be able to differentiate between SCI patients who cognitively decline over time vs those who do not.”

Clinical features of SCI may include changes in cognitive domain scores, specifically significant reduction in executive function, and declines in regional cerebral glucose metabolism. Providers should be aware, however, that anxiety and depression can mimic SCI in patients.

Predictors that a patient’s SCI will progress to mild cognitive impairment, according to a South Korean study mentioned in the presentation, included older age, lower scores on the Mini–Mental State Examination, carrier of the APOE-ε4 gene, lower verbal delayed recall scores, white matter hyperintensities, a worried-complainer personality, and low life satisfaction.

About half of patients with mild cognitive disorder will transition to Alzheimer’s disease over 5 years, Dr. Grossberg said. Although no therapies are approved by the US Food and Drug Administration for treating subjective or mild cognitive impairment, evidence suggests lifestyle modifications may slow progression.

“Clinicians need to advise their at-risk patients to control any and all cardiovascular risk factors—including hypertension, hyperlipidemia, diabetes, obesity, smoking, lack of exercise; keep mentally, physically, socially, and spiritually active; treat or avoid stress, anxiety, and depression (e.g., mindfulness and relaxation therapy); avoid head trauma (protect the brain); and adopt a Mediterranean diet,” Dr. Grossberg advised.

“By following these guidelines, patients have a better chance of delaying or decreasing their risk of Alzheimer’s disease.”

 —Jolynn Tumolo

Reference

“Mild Cognitive Impairment or Mild Neurocognitive Disorder: Implications for Clinical Practice.” Presented at the 29^th Annual U.S. Psychiatric & Mental Health Congress; October 23, 2016; San Antonio, TX.