# Presentation: 070492

## Mild Cognitive Impairment

**American Academy of Neurology**
**John Hart, Jr., M.D.**

## Mild Cognitive Impairment

**Definition: clinically defined by an impairment in one or more cognitive domains for age, but do not meet criteria for dementia ****(Petersen et al., 1999)**
**Significance: Mild Cognitive Impairment (MCI) is clinically identifiable precursor of dementia, particularly Alzheimer’s disease (AD)**

## Mild Cognitive Impairment

**Prevalence-population studies**** ****(Panza et al., 2005)**
**~3-5% for age 60 and older**
**~15% for age 75 and older**** **
**Incidence ****(Bischkopf et al., 2002)**
**Slightly higher for men than women **
**Higher in older or with less education**
**~12-15 per 1000 person-years for 65 and older**
**~54 per 1000 person-years for age 75 and older**

## Mild Cognitive Impairment

**Established clinical consensus criteria**** ****(Winblad et al., 2004)**
**Patient is not normal, but not demented (DSM-IV)**
**Evidence of cognitive deterioration for age**
**Objective measured decline over time in cognitive task performance, and/or**
**Subjective report of decline by patient and/or informant **_**and**_** objective cognitive deficits**
**Preserved activities of daily living and minimal to no impairment on complex instrumental functions**

## Mild Cognitive Impairment

**Rate of progression to dementia:**
**Mayo Study: 220 followed for 3-6 years**
**~12% per year (~1-2% for population)**
**Religious Study: 211 followed for ~4.5 years**
**30% deceased (1.7x higher than w/o MCI)**
**34% converted to AD (3.1x higher than  w/o MCI)**** ****(Bennett et al., 2002)**
**Can progress to AD, vascular dementia**** ****(Solfrizzi et al., 2004),**** ****Lewy Body Dementia**** ****(Bennett et al., 2005)**

## Mild Cognitive Impairment

**Neuropsychological impairments initially described for verbal and visual memory – amnestic MCI ****(Petersen et al., 1999)**
**Deficits now described in single or multiple cognitive domains (e.g., language, visuospatial) yielding ****(Petersen, 2004; Winblad et al., 2004; Lopez et al., 2005)**
**Multidomain amnestic (multiple cognitive domains including memory)**
**Multidomain nonamnestic**
**Single domain nonmemory**

## Pathology

**Possible etiologies are**
**Degenerative, vascular, metabolic, traumatic, psychiatric, or combination  **
**Pathology reflects condition as progresses**
**If deceased prior to conversion to dementia, pathology is intermediate between normal and AD pathology**

## Mild Cognitive Impairment

**No other specific code captures**
**Code needed as significant number diagnosed and diagnosis has profound implications**
**General dementia diagnoses (290.x) not accurate since MCI has cognitive deficits but not impaired daily functions**
**Memory loss (780.93) not capture since MCI does not have to be memory impairment**

## Mild Cognitive Impairment

**Organic personality syndrome (310.1) is for a memory deficit occurring after organic damage and refers primarily to the personality change**
**Transient global amnesia***** *****(437.7) not relevant since MCI not transient**
**Alzheimer’s disease (331.0), Vascular dementia (290.4), Frontotemporal dementias (331.19), and Dementia with Lewy Bodies (331.82) not accurate since are dementias**

## Mild Cognitive Impairment

**Would recommend coding in 331.x series (331.8)**
**Is not simply memory loss**
**Is a significant clinical change in cognitive status**
**Mild Cognitive Impairment (331.83)**