Mild Cognitive Impairment: Clinical Characterization and Outcome | Dementia and Cognitive Impairment | JAMA Neurology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Petersen  RC Normal aging, mild cognitive impairment, and early Alzheimer's disease.  Neurologist. 1995;1326- 344Google Scholar
Flicker  CFerris  SHReisberg  B Mild cognitive impairment in the elderly: predictors of dementia.  Neurology. 1991;411006- 1009Google ScholarCrossref
Tierney  MCSzalai  JPSnow  WG  et al.  A prospective study of the clinical utility of ApoE genotype in the prediction of outcome in patients with memory impairment.  Neurology. 1996;46149- 154Google ScholarCrossref
Minoshima  SGiordani  BBerent  SFrey  KFoster  NKuhl  D Metabolic reduction in the posterior cingulate cortex in very early Alzheimer's disease.  Ann Neurol. 1997;4285- 94Google ScholarCrossref
Dawe  BProcter  APhilpot  M Concepts of mild memory impairment in the elderly and their relationship to dementia: a review.  Int J Geriatr Psychiatry. 1992;7473- 479Google ScholarCrossref
Grundman  MPetersen  RMorris  J  et al.  Rate of dementia of the Alzheimer type (DAT) in subjects with mild cognitive impairment [abstract].  Neurology. 1996;46A403Google ScholarCrossref
Morris  JCMcKeel  DWStorandt  M  et al.  Very mild Alzheimer's disease: informant based clinical, psychometric, and pathologic distinction from normal aging.  Neurology. 1991;41469- 478Google ScholarCrossref
Petersen  RCSmith  GEIvnik  RJ  et al.  Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals.  JAMA. 1995;2731274- 1278Google ScholarCrossref
Petersen  RCWaring  SCSmith  GETangalos  EGThibodeau  SN Predictive value of APOE genotyping in incipient Alzheimer's disease.  Ann N Y Acad Sci. 1996;80258- 69Google ScholarCrossref
Petersen  RCKokmen  ETangalos  EIvnik  RJKurland  LT Mayo Clinic Alzheimer's Disease Patient Registry.  Aging. 1990;2408- 415Google Scholar
Petersen  RCSmith  GKokmen  EIvnik  RJTangalos  EG Memory function in normal aging.  Neurology. 1992;42396- 401Google ScholarCrossref
Petersen  RCSmith  GEIvnik  RJKokmen  ETangalos  EG Memory function in very early Alzheimer's disease.  Neurology. 1994;44867- 872Google ScholarCrossref
Kokmen  ENaessens  JMOfford  KP A Short Test of Mental Status: description and preliminary results.  Mayo Clin Proc. 1987;62281- 288Google ScholarCrossref
Kokmen  ESmith  GEPetersen  RCTangalos  EIvnik  RJ The short test of mental status: correlations with standardized psychometric testing.  Arch Neurol. 1991;48725- 728Google ScholarCrossref
Rosen  WTerry  R Pathological verification of ischemic score differentiation of dementias.  Ann Neurol. 1980;7486- 488Google ScholarCrossref
Weintraub  S The record of independent living: an informant-completed measure of activities of daily living and behavior in elderly patients with cognitive impairment.  Am J Alzheimer Care Rel Disord. 1986;735- 39Google ScholarCrossref
Sheikh  JIYesavage  JA Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Brink  TLed. Clinical Gerontology: A Guide to Assessment and Intervention. Binghamton, NY Haworth Press Inc1986;165- 173Google Scholar
Lezak  MD Neuropsychological Assessment, Third Edition.  New York, NY Oxford University Press Inc1995;
Folstein  MFFolstein  SEMcHugh  PR "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician.  J Psychiatr Res. 1975;12189- 198Google ScholarCrossref
Mattis  S Dementia Rating Scale: Professional Manual.  Odessa, Fla Psychological Assessment Resources Inc1988;
Grober  EBuschke  H Genuine memory deficits in dementia.  Dev Neuropsychol. 1987;313- 36Google ScholarCrossref
Buschke  H Cued recall in amnesia.  J Clin Neurophysiol. 1984;6433- 440Google Scholar
Buschke  H Control of cognitive processing. Squire  LRButters  Neds. Neuropsychology of Memory. New York, NY Guilford Press1984;37- 40Google Scholar
Kaplan  EFGoodglass  HWeintraub  S The Boston Naming Test.  Boston, Mass E Kaplan & H Goodglass1978;
Benton  ALHamsher  KVarney  NRSpreen  O Contributions to Neuropsychological Assessment.  New York, NY Oxford University Press Inc1983;
Monsch  AUBondi  MWButters  N  et al.  A comparison of category and letter fluency in Alzheimer's disease and Huntington's disease.  Neuropsychology. 1994;825- 30Google ScholarCrossref
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition.  Washington, DC American Psychiatric Association1987;
McKhann  GDrachman  DFolstein  MKatzman  RPrice  DStadlan  EM Clinical Diagnosis of Alzheimer's Disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.  Neurology. 1984;34939- 944Google ScholarCrossref
Morris  JC The Clinical Dementia Rating (CDR): current version and scoring rules.  Neurology. 1993;432412- 2414Google ScholarCrossref
Berg  L Clinical Dementia Rating (CDR).  Psychopharm Bull. 1988;24637- 639Google Scholar
Reisberg  BFerris  SdeLeon  MJCrook  T The Global Deterioration Scale for assessment of primary degenerative dementia.  Am J Psychiatry. 1982;1301136- 1139Google Scholar
Ivnik  RJMalec  JFSmith  GE  et al.  Mayo's Older Americans Normative Studies: WAIS-R norms for ages 56 to 97.  Clin Neuropsychol. 1992;6(suppl)1- 30Google ScholarCrossref
Ivnik  RJMalec  JFSmith  GE  et al.  Mayo's Older Americans Normative Studies: WMS-R norms for ages 56 to 94.  Clin Neuropsychol. 1992;6(suppl)49- 82Google ScholarCrossref
Ivnik  RJSmith  GETangalos  EGPetersen  RCKokmen  EKurland  LT Wechsler Memory Scale (WMS): I.Q. dependent norms for persons ages 65-97 years: Psychological Assessment:  J Consult Clin Psychol. 1991;3156- 161Google Scholar
Ivnik  RJMalec  JFSmith  GETangalos  EGPetersen  RC Neuropsychological tests' norms above age 55: COWAT, BNT, MAE Token, WRAT-R Reading, AMNART, STROOP, TMT and JLO.  Clin Neuropsychol. 1996;10262- 278Google ScholarCrossref
McGlone  JGupta  SHumphrey  DOppenheimer  SMirsen  TEvans  DR Screening for early dementia using memory complaints from patients and relatives.  Arch Neurol. 1990;471189- 1193Google ScholarCrossref
Morris  JCStorandt  MMcKeel  DW  et al.  Cerebral amyloid deposition and diffuse plaques in "normal" aging.  Neurology. 1996;46707- 719Google ScholarCrossref
Tierney  MCSzalai  JPSnow  WG  et al.  Prediction of probable Alzheimer's disease in memory-impaired patients: a prospective longitudinal study.  Neurology. 1996;46661- 665Google ScholarCrossref
Bowen  JTeri  LKukull  WMcCormick  WMcCurry  SLarson  E Progression to dementia in patients with isolated memory loss.  Lancet. 1997;349763- 765Google ScholarCrossref
Petersen  RCSmith  GEKokmen  EIvnik  RJTangalos  EG Memory function in normal aging.  Neurology. 1992;42396- 401Google ScholarCrossref
Jack  CRPetersen  RCXu  Y-C  et al.  Medial temporal atrophy on MRI in normal aging and very mild Alzheimer's disease.  Neurology. 1997;49786- 794Google ScholarCrossref
Lemsky  CChulune  GFerman  TJIvnik  RJ Detecting clinically relevant memory changes in elderly patients.  J Int Neuropsychol Soc. 1998;453Google Scholar
Original Contribution
March 1999

Mild Cognitive Impairment: Clinical Characterization and Outcome

Author Affiliations

From the Departments of Neurology (Drs Petersen and Kokmen), Health Sciences Research (Drs Petersen and Waring), and Psychiatry and Psychology (Drs Smith and Ivnik), and the Division of Community Internal Medicine (Dr Tangalos), Mayo Clinic, Rochester, Minn.

Arch Neurol. 1999;56(3):303-308. doi:10.1001/archneur.56.3.303

Background  Subjects with a mild cognitive impairment (MCI) have a memory impairment beyond that expected for age and education yet are not demented. These subjects are becoming the focus of many prediction studies and early intervention trials.

Objective  To characterize clinically subjects with MCI cross-sectionally and longitudinally.

Design  A prospective, longitudinal inception cohort.

Setting  General community clinic.

Participants  A sample of 76 consecutively evaluated subjects with MCI were compared with 234 healthy control subjects and 106 patients with mild Alzheimer disease (AD), all from a community setting as part of the Mayo Clinic Alzheimer's Disease Center/Alzheimer's Disease Patient Registry, Rochester, Minn.

Main Outcome Measures  The 3 groups of individuals were compared on demographic factors and measures of cognitive function including the Mini-Mental State Examination, Wechsler Adult Intelligence Scale–Revised, Wechsler Memory Scale–Revised, Dementia Rating Scale, Free and Cued Selective Reminding Test, and Auditory Verbal Learning Test. Clinical classifications of dementia and AD were determined according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition and the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association criteria, respectively.

Results  The primary distinction between control subjects and subjects with MCI was in the area of memory, while other cognitive functions were comparable. However, when the subjects with MCI were compared with the patients with very mild AD, memory performance was similar, but patients with AD were more impaired in other cognitive domains as well. Longitudinal performance demonstrated that the subjects with MCI declined at a rate greater than that of the controls but less rapidly than the patients with mild AD.

Conclusions  Patients who meet the criteria for MCI can be differentiated from healthy control subjects and those with very mild AD. They appear to constitute a clinical entity that can be characterized for treatment interventions.