Origins, Controversies and Recent Developments of the MCI Construct
Origins, Controversies and Recent Developments of the MCI Construct
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DOI：
10.2174/156720510791050858
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发表时间：
2010-05-01
影响因子：
2.1
通讯作者：
Gainotti, G.
中科院分区：
文献类型：
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作者：
Gainotti, G.
轻度认知障碍（MCI）这一概念旨在探究正常衰老与痴呆之间存在的灰色区域，以便在临床前阶段识别出有患痴呆风险的患者。MCI概念的提出是以阿尔茨海默病（AD）的神经病理学分期为参考，并提供了一套明确的识别标准，但它引发了两个主要问题：（a）关于从MCI转化为痴呆的实际转化率的估计存在差异，（b）恢复正常的受试者数量。这些问题部分源于MCI识别标准在操作上遇到的困难，这些困难涉及：所使用的记忆测试、用于识别有“客观”记忆障碍患者所采用的临界值、主观记忆障碍的评估以及日常生活活动能力的完整性。在对这些操作困难进行简短讨论之后，我将简要综述那些对MCI转化为痴呆具有额外预测价值的实验室数据（载脂蛋白E4、脑脊液生物标志物、神经影像学数据以及血管危险因素），以及一些近期识别仅有纯粹主观认知障碍的轻度认知障碍前期患者的尝试。我将通过询问我们是只有一种MCI还是有一系列MCI概念来结束我的综述，其中每一种在特定的临床背景下都可能发挥优先作用。
The MCI construct aims to investigate the grey area existing between normal aging and dementia, in order to identify in the preclinical stage patients at risk of developing dementia.The construct of the MCI has been proposed by taking the neuropathological staging of the Alzheimer's disease (AD) as reference and providing an explicit set of identifying criteria, but it has raised two main problems: (a) the variability of estimates concerning the actual rate of conversion from MCI to dementia, and (b) the number of subjects who return to normality. These problems stem in part from the operational difficulties met by the MCI identifying criteria concerned with: the memory tests used, the cut-off adopted to identify patients with an 'objective' memory disorder, the assessment of subjective memory disorders, and the integrity of daily living activities. After a short discussion of these operational difficulties, I will pass to shortly survey the laboratory data providing additional predictive value for the conversion of MCI to dementia (ApoE4, CSF biomarkers, Neuroimaging data, and Vascular risk factors) and some recent attempts to identify pre-MCI patients, with a purely subjective cognitive impairment. I will conclude my review by asking if we have a single MCI or a family of MCI constructs, each of whom could play a preferential role in specific clinical contexts.