AMNESTIC MINIMAL COGNITIVE IMPAIRMENT: BEYOND MEMORY

Transcription

1 AMNESTIC MINIMAL COGNITIVE IMPAIRMENT: BEYOND MEMORY R. Balachandar 1,, R. Tripati 2, S. Bharath 1, S. Sadanand 1, P. T. Sivakumar 1, K. Kumar 2, S. Loganathan 1, S. R. Chandra 3, M. Vargese 1 1 Dept. Psychiatry, 2 Dept. Clinical Psychology, 3 Dept. Neurology, National Institute of Mental Health And Neuroscience, Bangalore, India Declare no conflict of interest

2 INTRODUCTION Mild cognitive impairment (MCI) defines a transitional state along a continuous spectrum that goes from normal aging to fully developed dementia MCI patients typically complain of cognitive deficits that do not interfere, or interfere only mildly, with their everyday- life activities.

3 amci is classified as single domain amci (memory alone) and multi domain amci (memory, executive function, language, attention or visuo-spatial skills), isolated amci is a rare variant.

4 OBJECTIVES Here we try to explore the hypothesis that the amci is usually associated with cognitive domains more than the memory component alone.

5 METHODOLOGY amci patients (N=34,F=9) visiting geriatric clinic, NIMHANS, India, from March2011- September2012, diagnosed according to Peterson, 1999 criteria and CDR=0.5 were assessed for cognitive deficits. Age, gender, education and occupation matched cognitively Normal subjects (CNs) (N=37, F=8) were also assessed with the same battery of tests. CNs were recruited from community & spouses of the patients visiting the hospital All subjects were screened for other major neuorpsychiatric illness to rule out other causes of cognitive impairment

6 METHODOLOGY (cont..) This battery of test assessed memory (logical memory, visuo-spatial memory, semantic memory) attention (digit span, spatial span) and executive functions (category fluency tests). Statistical analyses were performed using R- statistics.

7 RESULTS Demographic details CNs MCI (P) Sample Size age 67.1 ± ± gender (F:M) 8:29 9:25 education 13.4 ± ±

8 Test (CNs:MCI) MEMORY (Results cont..) MCI (mean) MCI (Std. Dn) CNs (mean) CNs (Std. Dn) Logical Memory (IR) (35:33) Logical Memory (DR) (35:33) Visuo-spatial memory (Copy) (36:34) Visuo-spatial memory (IR) (36:34) Visuo-spatial memory (DR) (36:34) Word List Learning (Trial - 1) (36:34) Word List Learning (Trial - 2) (36:34) Word List Learning (Trial - 3) (36:34) Word List (DR) (36:34) Word List (Recognition) (36:34) (P) IR: Immediate Recall, DR: Delayed Recall P < , ( significant after Bon-ferroni correction) P < 0.05 (not significant after multiple correction)

9 Test (CNs:MCI) OTHER DOMAINS (Results cont..) MCI (mean) MCI Std.Dn CNs (Mean) CNs Std Dn (P) Digit Span (F) (37:34) Digit Span ( R ) (37:34) Spatial Span (F) (36:33) Spatial Span ( R ) (36:33) Fluency (Fr) (37:34) Fluency (A) (37:34) Fluency (V) (37:34) Vigilance test (Total Time) (35:27) Vigilance test (Er-Ommision) (35:30) Vigilance test (Er-Commision) (35:29) F: Forward, R: Reverse, A: Animals, Fr : fruits, V: Vegetables P < 0.05 (not significant after multiple correction) P < , ( significant after Bon-ferroni correction)

10 DISCUSSION In this study we have explored the cognitive domains that are affected in amci. MCI group performed inferiorly compared to the CNs group in domains like memory, executive function (Bon-Ferroni corrected) MCI performed inferiorly in tasks that assessed attention (but significance dropped > 0.05 after Bon-Ferroni correction).

11 However human brain is a complex association of networks in which isolated loss of single cognitive domain is a rare variant. Executive function Memory Visuo-Spatial Skills Emotion/ motivation Language Integrated Cognition Attention Integrated Behavior Cumings et al 2003

12 CONCLUSION This study has shown that MCI is associated cognitive dysfunction in the attention, executive functions along with the memory when compared to the matched cnc. Hence isolated single domain amci is rare variant and whether such an entity exists is questionable. LIMITATIONS Cross sectional study Sample size limited Study design (group comparison)

13 Acknowledgements for listening Funding PhD fellowship Travel support