Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2005 Nov;76(11):1485–1490. doi: 10.1136/jnnp.2004.050385

The Goteborg MCI study: mild cognitive impairment is a heterogeneous condition

A Nordlund 1, S Rolstad 1, P Hellstrom 1, M Sjogren 1, S Hansen 1, A Wallin 1
PMCID: PMC1739388  PMID: 16227535

Abstract

Background: Mild cognitive impairment (MCI) has been considered a transitional state between normal aging and dementia, characterised by memory impairment but normal general cognitive functioning. Recently other cognitive deficits have been reported. This has led to a modification of MCI criteria.

Objective: To examine which neuropsychological tests most clearly distinguish MCI subjects from normal controls.

Methods: 112 consecutive MCI subjects and 35 controls were included in the study. The diagnosis of MCI was based on an objective history of cognitive decline and a neuropsychiatric examination, comprising instruments STEP, I-Flex, MMSE, and CDR. Participants were examined with 21 neuropsychological tests in the cognitive domains speed/attention, memory and learning, visuospatial function, language, and executive function.

Results: Controls were significantly older. No differences were found in education or general intellectual capacity. Controls performed significantly better than MCI on tests within all five cognitive domains. The clearest differences were seen on language tests, followed by executive function, and learning and memory. Only two subjects (1.8%) were purely amnestic; 17% showed no impairment compared with controls, with a cut off of 1.5 SD below age mean. These subjects were better educated and performed significantly better on measures of general cognitive capacity.

Conclusions: The results illustrate the heterogeneity of MCI, with a significant degree of impairment in all five cognitive domains. When examined with a comprehensive neuropsychological battery, very few subjects had an isolated memory impairment.

Full Text

The Full Text of this article is available as a PDF (79.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bandera R., Capitani E., Della Sala S., Spinnler H. Discrimination between senile dementia Alzheimer type patients and -education matched normal controls by means of a 6-test set. Ital J Neurol Sci. 1985 Sep;6(3):339–344. doi: 10.1007/BF02232012. [DOI] [PubMed] [Google Scholar]
  2. Binetti G., Cappa S. F., Magni E., Padovani A., Bianchetti A., Trabucchi M. Disorders of visual and spatial perception in the early stage of Alzheimer's disease. Ann N Y Acad Sci. 1996 Jan 17;777:221–225. doi: 10.1111/j.1749-6632.1996.tb34422.x. [DOI] [PubMed] [Google Scholar]
  3. Bowen J., Teri L., Kukull W., McCormick W., McCurry S. M., Larson E. B. Progression to dementia in patients with isolated memory loss. Lancet. 1997 Mar 15;349(9054):763–765. doi: 10.1016/S0140-6736(96)08256-6. [DOI] [PubMed] [Google Scholar]
  4. Bozoki A., Giordani B., Heidebrink J. L., Berent S., Foster N. L. Mild cognitive impairments predict dementia in nondemented elderly patients with memory loss. Arch Neurol. 2001 Mar;58(3):411–416. doi: 10.1001/archneur.58.3.411. [DOI] [PubMed] [Google Scholar]
  5. Celsis P. Age-related cognitive decline, mild cognitive impairment or preclinical Alzheimer's disease? Ann Med. 2000 Feb;32(1):6–14. doi: 10.3109/07853890008995904. [DOI] [PubMed] [Google Scholar]
  6. Chen P., Ratcliff G., Belle S. H., Cauley J. A., DeKosky S. T., Ganguli M. Cognitive tests that best discriminate between presymptomatic AD and those who remain nondemented. Neurology. 2000 Dec 26;55(12):1847–1853. doi: 10.1212/wnl.55.12.1847. [DOI] [PubMed] [Google Scholar]
  7. Collie A., Maruff P. The neuropsychology of preclinical Alzheimer's disease and mild cognitive impairment. Neurosci Biobehav Rev. 2000 May;24(3):365–374. doi: 10.1016/s0149-7634(00)00012-9. [DOI] [PubMed] [Google Scholar]
  8. Crook T., Bahar H., Sudilovsky A. Age-associated memory impairment: diagnostic criteria and treatment strategies. Int J Neurol. 1987 1988;21-22:73–82. [PubMed] [Google Scholar]
  9. Crossley M., D'Arcy C., Rawson N. S. Letter and category fluency in community-dwelling Canadian seniors: a comparison of normal participants to those with dementia of the Alzheimer or vascular type. J Clin Exp Neuropsychol. 1997 Feb;19(1):52–62. doi: 10.1080/01688639708403836. [DOI] [PubMed] [Google Scholar]
  10. Davis Heather S., Rockwood Kenneth. Conceptualization of mild cognitive impairment: a review. Int J Geriatr Psychiatry. 2004 Apr;19(4):313–319. doi: 10.1002/gps.1049. [DOI] [PubMed] [Google Scholar]
  11. Della Sala S., Baddeley A., Papagno C., Spinnler H. Dual-task paradigm: a means to examine the central executive. Ann N Y Acad Sci. 1995 Dec 15;769:161–171. doi: 10.1111/j.1749-6632.1995.tb38137.x. [DOI] [PubMed] [Google Scholar]
  12. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  13. Frisoni Giovanni B., Galluzzi Samantha, Bresciani Lorena, Zanetti Orazio, Geroldi Cristina. Mild cognitive impairment with subcortical vascular features: clinical characteristics and outcome. J Neurol. 2002 Oct;249(10):1423–1432. doi: 10.1007/s00415-002-0861-7. [DOI] [PubMed] [Google Scholar]
  14. Geffen G. M., Butterworth P., Geffen L. B. Test-retest reliability of a new form of the auditory verbal learning test (AVLT). Arch Clin Neuropsychol. 1994 Jul;9(4):303–316. [PubMed] [Google Scholar]
  15. Graham N. L., Emery T., Hodges J. R. Distinctive cognitive profiles in Alzheimer's disease and subcortical vascular dementia. J Neurol Neurosurg Psychiatry. 2004 Jan;75(1):61–71. [PMC free article] [PubMed] [Google Scholar]
  16. Grundman Michael, Petersen Ronald C., Ferris Steven H., Thomas Ronald G., Aisen Paul S., Bennett David A., Foster Norman L., Jack Clifford R., Jr, Galasko Douglas R., Doody Rachelle. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol. 2004 Jan;61(1):59–66. doi: 10.1001/archneur.61.1.59. [DOI] [PubMed] [Google Scholar]
  17. Guarch J., Marcos T., Salamero M., Blesa R. Neuropsychological markers of dementia in patients with memory complaints. Int J Geriatr Psychiatry. 2004 Apr;19(4):352–358. doi: 10.1002/gps.1074. [DOI] [PubMed] [Google Scholar]
  18. KRAL V. A. Senescent forgetfulness: benign and malignant. Can Med Assoc J. 1962 Feb 10;86:257–260. [PMC free article] [PubMed] [Google Scholar]
  19. Kivipelto M., Helkala E. L., Hänninen T., Laakso M. P., Hallikainen M., Alhainen K., Soininen H., Tuomilehto J., Nissinen A. Midlife vascular risk factors and late-life mild cognitive impairment: A population-based study. Neurology. 2001 Jun 26;56(12):1683–1689. doi: 10.1212/wnl.56.12.1683. [DOI] [PubMed] [Google Scholar]
  20. Lautenschlager N. T., Riemenschneider M., Drzezga A., Kurz A. F. Primary degenerative mild cognitive impairment: study population, clinical, brain imaging and biochemical findings. Dement Geriatr Cogn Disord. 2001 Nov-Dec;12(6):379–386. doi: 10.1159/000051284. [DOI] [PubMed] [Google Scholar]
  21. Levy R. Aging-associated cognitive decline. Working Party of the International Psychogeriatric Association in collaboration with the World Health Organization. Int Psychogeriatr. 1994 Spring;6(1):63–68. [PubMed] [Google Scholar]
  22. Luis C. A., Loewenstein D. A., Acevedo A., Barker W. W., Duara R. Mild cognitive impairment: directions for future research. Neurology. 2003 Aug 26;61(4):438–444. doi: 10.1212/01.wnl.0000080366.90234.7f. [DOI] [PubMed] [Google Scholar]
  23. Lukatela K., Malloy P., Jenkins M., Cohen R. The naming deficit in early Alzheimer's and vascular dementia. Neuropsychology. 1998 Oct;12(4):565–572. doi: 10.1037//0894-4105.12.4.565. [DOI] [PubMed] [Google Scholar]
  24. Maylor Elizabeth A., Smith Geoff, Della Sala Sergio, Logie Robert H. Prospective and retrospective memory in normal aging and dementia: an experimental study. Mem Cognit. 2002 Sep;30(6):871–884. doi: 10.3758/bf03195773. [DOI] [PubMed] [Google Scholar]
  25. Meyer John Stirling, Xu Gelin, Thornby John, Chowdhury Munir H., Quach Minh. Is mild cognitive impairment prodromal for vascular dementia like Alzheimer's disease? Stroke. 2002 Aug;33(8):1981–1985. doi: 10.1161/01.str.0000024432.34557.10. [DOI] [PubMed] [Google Scholar]
  26. Morris J. C., Storandt M., Miller J. P., McKeel D. W., Price J. L., Rubin E. H., Berg L. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol. 2001 Mar;58(3):397–405. doi: 10.1001/archneur.58.3.397. [DOI] [PubMed] [Google Scholar]
  27. Palmer Katie, Fratiglioni Laura, Winblad Bengt. What is mild cognitive impairment? Variations in definitions and evolution of nondemented persons with cognitive impairment. Acta Neurol Scand Suppl. 2003;179:14–20. doi: 10.1034/j.1600-0404.107.s179.2.x. [DOI] [PubMed] [Google Scholar]
  28. Paolo A. M., Axelrod B. N., Tröster A. I., Blackwell K. T., Koller W. C. Utility of a Wisconsin Card Sorting Test short form in persons with Alzheimer's and Parkinson's disease. J Clin Exp Neuropsychol. 1996 Dec;18(6):892–897. doi: 10.1080/01688639608408310. [DOI] [PubMed] [Google Scholar]
  29. Petersen R. C., Doody R., Kurz A., Mohs R. C., Morris J. C., Rabins P. V., Ritchie K., Rossor M., Thal L., Winblad B. Current concepts in mild cognitive impairment. Arch Neurol. 2001 Dec;58(12):1985–1992. doi: 10.1001/archneur.58.12.1985. [DOI] [PubMed] [Google Scholar]
  30. Petersen R. C., Smith G. E., Waring S. C., Ivnik R. J., Kokmen E., Tangelos E. G. Aging, memory, and mild cognitive impairment. Int Psychogeriatr. 1997;9 (Suppl 1):65–69. doi: 10.1017/s1041610297004717. [DOI] [PubMed] [Google Scholar]
  31. Petersen R. C., Smith G. E., Waring S. C., Ivnik R. J., Tangalos E. G., Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999 Mar;56(3):303–308. doi: 10.1001/archneur.56.3.303. [DOI] [PubMed] [Google Scholar]
  32. Rasquin S. M. C., Lodder J., Visser P. J., Lousberg R., Verhey F. R. J. Predictive accuracy of MCI subtypes for Alzheimer's disease and vascular dementia in subjects with mild cognitive impairment: a 2-year follow-up study. Dement Geriatr Cogn Disord. 2004 Dec 9;19(2-3):113–119. doi: 10.1159/000082662. [DOI] [PubMed] [Google Scholar]
  33. Reisberg B., Ferris S. H., de Leon M. J., Crook T. Global Deterioration Scale (GDS). Psychopharmacol Bull. 1988;24(4):661–663. [PubMed] [Google Scholar]
  34. Rentz Dorene M., Huh Terri J., Faust Robert R., Budson Andrew E., Scinto Leonard F. M., Sperling Reisa A., Daffner Kirk R. Use of IQ-adjusted norms to predict progressive cognitive decline in highly intelligent older individuals. Neuropsychology. 2004 Jan;18(1):38–49. doi: 10.1037/0894-4105.18.1.38. [DOI] [PubMed] [Google Scholar]
  35. Ritchie K., Artero S., Touchon J. Classification criteria for mild cognitive impairment: a population-based validation study. Neurology. 2001 Jan 9;56(1):37–42. doi: 10.1212/wnl.56.1.37. [DOI] [PubMed] [Google Scholar]
  36. Royall D. R., Mahurin R. K., Gray K. F. Bedside assessment of executive cognitive impairment: the executive interview. J Am Geriatr Soc. 1992 Dec;40(12):1221–1226. doi: 10.1111/j.1532-5415.1992.tb03646.x. [DOI] [PubMed] [Google Scholar]
  37. Smith G., Ivnik R. J., Petersen R. C., Malec J. F., Kokmen E., Tangalos E. Age-associated memory impairment diagnoses: problems of reliability and concerns for terminology. Psychol Aging. 1991 Dec;6(4):551–558. doi: 10.1037//0882-7974.6.4.551. [DOI] [PubMed] [Google Scholar]
  38. Stern Yaakov. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002 Mar;8(3):448–460. [PubMed] [Google Scholar]
  39. Storandt Martha, Grant Elizabeth A., Miller J. Philip, Morris John C. Rates of progression in mild cognitive impairment and early Alzheimer's disease. Neurology. 2002 Oct 8;59(7):1034–1041. doi: 10.1212/wnl.59.7.1034. [DOI] [PubMed] [Google Scholar]
  40. Tierney M. C., Szalai J. P., Snow W. G., Fisher R. H., Nores A., Nadon G., Dunn E., St George-Hyslop P. H. Prediction of probable Alzheimer's disease in memory-impaired patients: A prospective longitudinal study. Neurology. 1996 Mar;46(3):661–665. doi: 10.1212/wnl.46.3.661. [DOI] [PubMed] [Google Scholar]
  41. Visser P. J., Verhey F. R., Ponds R. W., Jolles J. Diagnosis of preclinical Alzheimer's disease in a clinical setting. Int Psychogeriatr. 2001 Dec;13(4):411–423. doi: 10.1017/s1041610201007839. [DOI] [PubMed] [Google Scholar]
  42. Wallin A., Edman A., Blennow K., Gottfries C. G., Karlsson I., Regland B., Sjögren M. Stepwise comparative status analysis (STEP): a tool for identification of regional brain syndromes in dementia. J Geriatr Psychiatry Neurol. 1996 Oct;9(4):185–199. doi: 10.1177/089198879600900406. [DOI] [PubMed] [Google Scholar]
  43. Wilson R. S., Kaszniak A. W., Bacon L. D., Fox J. H., Kelly M. P. Facial recognition memory in dementia. Cortex. 1982 Oct;18(3):329–336. doi: 10.1016/s0010-9452(82)80031-2. [DOI] [PubMed] [Google Scholar]
  44. Wolf H., Grunwald M., Ecke G. M., Zedlick D., Bettin S., Dannenberg C., Dietrich J., Eschrich K., Arendt T., Gertz H. J. The prognosis of mild cognitive impairment in the elderly. J Neural Transm Suppl. 1998;54:31–50. doi: 10.1007/978-3-7091-7508-8_4. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES