Clinical practice guidelines for assessment and management of mild neurocognitive disorder

Indian Journal of Psychiatry, Journal Year: 2025, Volume and Issue: 67(1), P. 21 - 40

Published: Jan. 1, 2025

INTRODUCTION Today, neuroscience has progressed to understand that dementia is actually a late diagnosis. Just as cholesterol plaques start in the vascular system early first decade of life, so too brain degeneration may predate manifestation frank symptoms by 2–3 decades. Therefore, it important if clinically there gray zone between apparent normal functioning and obvious decline. This gap what mild cognitive impairment or neurocognitive disorder (Mild NCD) is. A seminal discussion 2003 led acceptance Mild NCD separate entity definition based on Petersen's criteria. Subsequently, these were modified Winblad criteria those defined NIA-AA (National Institute Ageing Alzheimer's Association) well fifth edition Diagnostic Statistical Manual Mental Disorders, DSM-5 (which spoke NCD). The common thread all was subjective recognition errors, objective decline neuropsychological tests, relatively intact ability carry with activities daily living, combination which could lead adequate distress anxiety.[1] Hence, systematic research same approach assessment care are really need hour. In India, even more limited, hence, this guideline, best advised practices, followed easily subcontinent, can be easy for treating psychiatrist manage. PROCESS OF DEVELOPMENT development Clinical Practice Guidelines (CPG) management rigorous effort exclusively team psychiatrists from leading institutions across India. guidelines crafted an extensive review latest scientific literature, including national international such National Aging-Alzheimer's Association (NIA-AA), Disorders (DSM-5), International Classification Diseases (ICD-11). process driven address specific challenges nuances diagnosing managing within Indian population. expert engaged multiple rounds discussions deliberations ensure evidence-based, sound, tailored context. Following this, draft deliberated IPS workshop, incorporating inputs professionals throughout country. focus creating comprehensive resource reflects both current understanding practical realities faced resulting aim standardize enhance quality provided individuals NCD, ensuring have reliable relevant framework diagnosis management. These clinicians per individual's feasibility, available facilities setup. COGNITIVE RESERVE When discussing about becomes imperative reserve how assess it. Cognitive (CR) nothing but brain's cope neuropathology/neurodegeneration exploiting pre-existing processes and/or compensatory mechanisms, supposedly built through number factors over years. It flexibility efficiency utilizing resources maintain function despite aging disease [Figure 1].Figure 1: its significanceAssessing crucial individual differences susceptibility dementia. helps identifying at higher risk tailoring interventions bolster lifestyle modifications targeted training. Although no gold standard tests available, certain proxies cumulatively reflective CR [Table 1].Table Proxies their assessment[ 2 , 3 ]Some scales also been formulated using one above domains not widely used researched 2].Figure 2: Scales CR[ ]MILD AS DIAGNOSTIC ENTITY transition very early-stage various terms, prodrome, incipient dementia, isolated memory impairment. Over years, become term will here purpose discussion. MILD positioned continuum, overlapping stages ends 3], indicating distinction ageing subtle challenging. However, gradually established distinct diagnosis, intervention strategies.[4]Figure 3: continuum showing overlap boundary dementiaSeveral terms connection before apart MCI time. Subjective (SCI) self-perceived abilities, particularly memory, without evidence standardized tests. represents earliest symptomatic Other terminologies are, example, benign senescence forgetfulness, age-associated (AACD), (AAMI), (CIND), recently 2].[5]Table Historical declinePATHOLOGY IN Along changes nomenclature, simultaneous occurred summarized Table 3. addition assessments, pathology deliberated. protein theories emphasize significant role abnormal accumulation aggregation brain, 4 summarizes key proteins involved, roles underlying mechanisms.Table Evolution entityTable 4: Protein etiopathogenesis NCD[ 7 ]SUBTYPES heterogeneous presentations, depending upon affected domain. Due classified basis domain affected. classification relates etiology pathology, clinical presentation, outcomes. Figure shows subtypes probable outcome.[8] we less etiopathological probably simplistic NCD. Nevertheless, clinician know.Figure outcomesPROGRESSION course variable. always convert Around 20–40% cases appear improve time retesting. After subtype change follow-up. single seems shift. some found either retain status. Rates progression vary range (10–15% year) few outliers lower spectrum, around 80% approximately 10 keeps increasing exponentially each year.[8] Certain associated increased should specifically looked while 5].Table 5: Risk dementia[ 8 ]DELAY SEEKING TREATMENT although affect does interfere person's capacity independence everyday often gets overlooked, delays consultation, along other reasons 6].Table 6: Reasons delay seeking consultation person NCDNEED FOR ASSESSMENT AND EARLY DIAGNOSIS questioned owing nature symptoms. Evidence suggests remain stable, return neurologically conditions, progress further progressing compared age-matched controls higher, thus pathologic state rather than aging. needs timely interventions. Various listed 7.Table 7: Need NCDASSESSMENT PERSONS WITH SUSPECTED Any patient suspected having undergo detailed evaluation investigations. history physical examination [especially central nervous (CNS) examination], focusing detail status functions, medication use, neuropsychiatric evaluation, laboratory testing, neuroimaging, components 5].Figure Overview NCDHistory taking Taking patients accurate clarifying points mentioned 8.Table 8: Components elicited NCDThe incorporate following considerations detail: symptoms: Detailed 9].Table 9: Pointers parameters assessed (points b k) 10.Table 10: Specific explored section historyExamination Neurological Some findings neurological 11.[9] briefest examination, assessing extraocular movements gait whenever feasible.Table 11: High-yield neurologic symptomsNeuropsychological assessments mental case requires functions. would include testing already elaborated 'History taking'. usefulness 12.[9,10] six done sole practitioner OPD well.Table 12: NCDDiagnosis Both ICD-11 under category nearly similar diagnostic criteria.[11,12] ICD-10 mentions 'Mild Disorder' (F06.7) head 'Other disorders due damage dysfunction disease'[13] 13].Table 13: different systemsConsiderations making Excessive missing where lacks insight family denial. high individuals, whose currently 'normal' performance might 'decline his/her baseline'. Assessment (as explained earlier). Individuals show until they amount Second, sensitive enough detect individuals. reaching against age-appropriate norms educational cultural backgrounds, critical part NCDs, interesting note none definitions includes advanced age criterion, spite fact most occurs geriatric population presumed old age. Differential talking consider differential relation 6].[11]Figure Diffrential NCDInvestigations Labs causes causative contributory condition. taken into cognizance specifier 'Another Medical Condition' Neurocognitive Disorder DSM-5.[11] Similar many reversible causes, which, commonly, good prognosis optimum treatment conditions. Thus, potentially thoroughly investigated. ones 7, mode assessment.[14–16] essential elicit signs well, assessment, provide clues accordingly investigations, conducted. For metabolic generally manifestation, identified. Atrial fibrillation cause small, undetectable embolic events, small strokes transient ischemic attacks, ultimately impairment.Figure Potential causes/contributory assessmentNeuroimaging Neuroimaging routinely recommended helpful evaluating overall structure, serving purposes: Identifying conditions like tumors, pressure hydrocephalus, malformation, strokes. Serving potential biomarker (AD). lack consensus this. Advances structural functional neuroimaging providing valuable insights structural, functional, biochemical alterations enabling physicians make predicting accurately. Commonly observed 8.[17,18]Figure NCDRecently, newer methodologies existing techniques introduced value methods obtained data. MRI, morphometry being data processing, voxel-based, pattern-based, tensor-based, deformation-based. occur medial temporal lobe, entorhinal cortex, perirhinal hippocampus. Since neuronal hippocampus leads decrease volume, volumetric MRI scan commonly accepted method AD anatomic validity process, indication AD. Additionally, diffusion tensor imaging (DTI) studies demonstrated relationship white matter integrity severity. Optical coherence tomography links pathological retina dementia.[17] CSF study Several biomarkers identified AD.[19,20] three biomarkers—total tau, phospho-tau, Aβ42—are highly effective Testing markers accessible. Genetic biomarkers. considered any recent guidelines. features concerning genetic 9.[11] Importance indications Patients requiring imparted counseling beforehand cognition Application appropriate applicable patient's age, education, background, another require help areas cognition: attention, executive function, language, perceptual-motor skills, social cognition. incorporates domains. typically lies deviation (SD) (between 3rd 16th percentiles). properties 14.[10,21–23]Table 14: Properties tools NCDIn above, collect information caregivers/informants Informant Questionnaire Decline Elderly (IQCODE) Dementia Severity Rating Scale (DSRS). Memory Impairment Screen, Quick Screen Impairment, CDT- Sunderland, CERAD. functionality differentiate scales/tools available:[10,24] Lawton-Brody Instrumental Activities Daily Living: Subtle deficits instrumental living (IADL) noticed Functional (FAQ): Assess status, informant. score 6 85% accuracy distinguishing Performance Self-Care Skills (PASS) test: valid instrument measures occupational life activities. psychological behavioral subsequent caregiver Neuropsychiatric inventory (NPI) (NPI-Q), short questionnaire form NPI, depression Geriatric Depression (GDS).[25,26] presents algorithm NCD.Figure cliniciansMANAGEMENT Managing challenging variability symptoms, difficulty universally treatments. Effective focuses detection, regular monitoring, implementing strategies 11]. Treatment setting usually outpatient relies heavily nonpharmacological approved heterogeneity presentation. has, extent, contributed spread numerous myths regarding 15].Figure Priciple Interventions NCDTable 15: Common related 24 39 ]Goals Management goals largely forming collaborative approach, aiming reversal possible, effectively comorbidities, promoting health, independence, preparing progression, maintaining continuous monitoring 16], helping caregivers restructure environment achieve developing trusting therapeutic facilitate process.[27]Table 16: Goals 28 ]Interventions planned levels preventing reduction predisposing highlighted earlier point reduce later stage. possible 17.Table 17: ]Management As discussed section, treatable contribute Unfortunately, ignored underrated, though manageable significantly principle, 18.Table 18: Reversible management[ 16 ]Pharmacological Lecanemab (Leqembi), IgG1 monoclonal antibody, received accelerated Food Drug Administration (FDA) approval 2023. phase III trials, reduced amyloid slowing 27% placebo. Mechanism action: Reduce cerebral deposition, thereby reducing Route administration: mg/kg IV administered once every weeks Safety concerns: treatment-induced Amyloid-Related Imaging Abnormalities (ARIAs), homozygous ApoE ε4 genotype. serious side effects edema (ARIA-E) microhemorrhages (ARIA-H). Symptoms confusion, dizziness, headache, visual disturbances close warranted. Indications: Not non-AD cautiously ApoE-ε4 carriers ARIAs. Considerations cost, adverse effects, strict long-term safety addressed wide application.[29,30] Currently, pharmacological agents FDA 19 lists medications useful tried much effect.[16] Overall, pharmacologic supplement tested, shown benefits delaying Consequently, shifted approaches.Table 19: Pharmacological options ]Furthermore, measures; however, when warranted, psychotropics elderly prescribed depression, anxiety, sleep disturbance, apathy.[16,24,27] Neurostimulation There emerging utility noninvasive stimulation rTMS (repetitive transcranial magnetic stimulation) tDCS (transcranial direct More robust methodology needed impact NCD.[31] Nonpharmacological Remediation aims life. Early improvements, outcomes training (CT), rehabilitation (CR), (CS). Each goals, methods, types 20].Table 20: Types remediation difference them[ 32 ]These lasting positive healthy elder approaches involve varying tasks exercises targeting skill, affecting functioning, carried out individually group settings, specialized settings home, facilitated trained therapist member support 21].[32–36]Table 21: follows. Alternatively, correction table commentLifestyle modification seen greatly worsening promote health 22 below provides recommendations same. Nun Study protective choices revealed linguistic activity, cardiovascular presence pathology.[37] study, 10/66 Research Group indicated intake fish, rich omega-3 fatty acids, emphasizing neuroprotective anti-inflammatory acids,[38] reiterating importance dietary practices health.Table 22: Lifestyle ]Common pertaining Tailored Based personalized plan developed collaboration members, interventions, plans, settings. Provide implement Schedule follow-up appointments track necessary adjustments plan. By involving members create supportive promotes ensures practical, achievable, aligned preferences. Caregiver play supporting caregivers. burden, caregiving capabilities. interventions[40] 12.Figure givers NCDScheduling included visit NCD: validated consistently repeated comparative structured informant assessment. Details 23. 23: Follow-up 14 41 ] Ethical ethical dealing arise, especially context trials face issues disclosing ways navigate:[42–45]Table 24: recommendationsCapacity Capacity refers risks options, informed decision, communicate decision independently. intermediate transitional stage severe raises concerns decisions manage routine affairs. One concern participation making, previous section. Others tabulated 25].[46,47]Table 25: Issues persons domainsOVERVIEW MANAGEMENT An overview depicted 13.Figure NCDCONCLUSION Comprehensive prevent precise allows intervention. Integrating multidisciplinary approaches, training, treatments, modifications, Furthermore, recognizing NCD-related burden improving Regular monitor adjust plans accordingly. Continuous validation biomarkers, efficacy. adhering practice guidelines, comprehensive, structured, 26 ready reference practitioners.Table 26: NCDFinancial sponsorship Nil. Conflicts interest conflicts interest.

Language: Английский

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A systematic review and meta-analysis of pteridines in mild cognitive impairment and Alzheimer’s disease

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: Feb. 13, 2025

Language: Английский

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Predicting the Beneficial Effects of Cognitive Stimulation and Transcranial Direct Current Stimulation in Amnestic Mild Cognitive Impairment with Clinical, Inflammation, and Human Microglia Exposed to Serum as Potential Markers: A Double-Blind Placebo-Controlled Randomized Clinical Trial

International Journal of Molecular Sciences, Journal Year: 2025, Volume and Issue: 26(4), P. 1754 - 1754

Published: Feb. 19, 2025

In amnestic mild cognitive impairment (aMCI), neuroinflammation evolves during disease progression, affecting microglial function and potentially accelerating the pathological process. Currently, no effective treatment exists, leading to explorations of various symptomatic approaches, though few target underlying physiological mechanisms. Modulating inflammatory processes may be critical in slowing progression. Cognitive stimulation (CS) transcranial direct current (tDCS) applied left dorsolateral prefrontal cortex (l-DLPFC) show promise, but results are heterogeneous. Thus, a randomized, double-blind, placebo-controlled clinical trial is currently underway. The first-stage were examined after three weeks intervention two groups: active tDCS combined with CS sham CS. Twenty-two participants underwent assessments: T0 (baseline) T1 (after 15 sessions tDCS, or sham, 9 CS). demonstrated that improved cognition, increased brain-derived neurotrophic factor (BDNF) levels, reduced peripheral proinflammatory cytokine levels (interleukin IL-6 chemokine CX3CL1) serum. This decrease promote proliferation survival as modulatory effect response, while increase BDNF might suggest regulatory mechanism microglia-neuron interaction responses. However, did not enhance effects CS, suggesting longer interventions required achieve substantial benefits.

Language: Английский

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Cogstate Brief Battery performance in assessing cognitive impairment in Taiwan: A prospective, multi-center study

Journal of the Formosan Medical Association, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

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A Systematic Review of Natural Language Processing Techniques for Early Detection of Cognitive Impairment

Mayo Clinic Proceedings Digital Health, Journal Year: 2025, Volume and Issue: unknown, P. 100205 - 100205

Published: March 1, 2025

Language: Английский

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The role of neuropsychological assessment in the evaluation of patients with cognitive‐behavioral change due to suspected Alzheimer's disease and other causes of cognitive impairment and dementia

Alzheimer s & Dementia, Journal Year: 2024, Volume and Issue: 21(1)

Published: Dec. 28, 2024

The Alzheimer's Association convened a Diagnostic Evaluation, Testing, Counseling and Disclosure Clinical Practice Guideline workgroup to help combat the major global health challenges surrounding timely detection, accurate diagnosis, appropriate disclosure of mild cognitive impairment (MCI) or dementia due disease (AD) other diseases that cause these types cognitive-behavioral disorders. newly published clinical practice guidelines are proposed as structured approach evaluation. purpose present article is provide perspective on use neuropsychology within new framework outlined under Suspected Disease Related Disorders (DETeCD-ADRD) recommendations for primary care specialty care. Neuropsychological evaluation critical component in supporting early diagnosis staging, characterizing profile, assessing trajectory over time, providing specifically tailored individual their team. HIGHLIGHTS: Reviews neuropsychological (DETeCD-ADRD). Examines utility assessment (ADRD). Supports basis

Language: Английский

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