Géraud Dautzenberg

Chapter 1

Table 2. Criteria for (M)CI over the years. Original 1999 Mild Cognitive Impairment Criteria Recommendations

Minor NCD DSM 5 2013

Major NCD DSM 5 2013

General criteria for MCI 2004

-Memory complaint, preferably corroborated by an informant -Memory impairment documented according to appropriate reference values -Essentially normal performance in non memory cognitive domains -Generally preserved activities

Not normal, not demented (Does not meet criteria (DSM IV, ICD 10) for a dementia syndrome) Cognitive decline: -Self and/or informant report and impairment on objective cognitive tasks -Evidence of decline over time on objective cognitive tasks and / or Preserved basic activities of daily living / minimal

Moderate Cognitive Decline • NOT Interfere with independence • Not due to delirium • Not due to other mental disorder

Significant Cognitive Decline • (minimal) interfere with independence in everyday activities (ADL) • requiring assistance with instrumental activities of daily living (IADL) • Not due to delirium • Not due to other mental disorder

impairment in complex instrumental functions

ADL; activities of daily living. IADL; instrumental activities of daily living. NCD; neurocognitive disorder.

‘Dementia’: I often tell my patients that dementia is not a disease but an agreement between doctors. It defines a cognitive state that can be caused bymany different aetiologies, andmore than 50 cases have been reported. However, a large majority of these causes are attributed to Alzheimer’s disease (AD). Other common causes are vascular dementia, Lewy body dementia, and frontotemporal dementia. As always, we (the doctors) try to simplify things for our patients but not ourselves. Thus, there are many different agreements on what is considered dementia, but these agreements differ from each other. As our study was based on psychiatry, we used the DSM-IV, and later, the DSM 5 classification (the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000, 2013)) in the lead for dementia. However, we also incorporate the different classifications of different specialist or advocate groups per clinical disease, for example, NIA-AA/NINCDS-ADRDA for AD (McKhann et al. , 2011). The WHO describes dementia as ‘a syndrome occurring as a result of disease of the brain, which is usually chronic or progressive innature. It consists of impairment of several higher cortical functions, which include memory, thinking, comprehension, calculation, learning, language and judgement. These impairments often occur alongside changes in emotional control, social behaviour or motivation. Alzheimer’s disease and cerebrovascular disease are among the causes of dementia’. In general, one could summarise the global concept of ‘all-cause’ dementia as ‘the cognitive deficits are sufficient to interfere with independence

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