We thank Dr Akins for his interest in our study and for requesting additional studies of MCI so that data, rather than dogma, can clarify the issues. We agree with him that not every elderly individual with memory impairment is likely to have AD; as we specified in the article, we addressed only individuals for whom the differential diagnosis rests between MCI and AD and thus cannot comment about MCI caused by other conditions. We disagree with Dr Akins, however, in his challenge of our major conclusion: "The main finding from this study is that individuals considered by current criteria to have only MCI in fact have very mild AD."1 In our opinion this statement is amply supported by the data, which show that individuals with a CDR of 0.5 and dementia of the Alzheimer type who fulfill MCI criteria progress uniformly to even greater stages of dementia and almost always demonstrate neuropathologic AD at autopsy. Although such patients are being labeled by others with the etiologically vague designation of MCI, we consider them to have very mild dementia. We suggest that physicians recalibrate the threshold at which they make a reasonable diagnosis of AD so that dementia management can ensue at the earliest appropriate opportunity.
Morris JC, Storandt M, Miller JP, McKeel DW, Price JL, Rubin EH, Berg L. In reply. Arch Neurol. 2001;58(10):1705-1706. doi: