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Mild cognitive impairment in the oldest old

From the Departments of Neurology (Drs. Boeve, Kokmen, Knopman, and Petersen), Psychiatry and Psychology (Drs. Smith, Rummans, and Ivnik), Health Sciences Research (Drs. Edland and Petersen, T. Carpenter), and Internal Medicine (Dr. Tangalos), and Mayo Alzheimer’s Disease Research Center (Drs. Boeve, Smith, Ferman, Rummans, Ivnik, Kokmen, Tangalos, Edland, Knopman, and Petersen, J. McCormick), Mayo Clinic, Rochester, MN; and Department of Psychiatry and Psychology (Dr. Ferman), Mayo Clinic, Jacksonville, FL.

Address correspondence and reprint requests to Dr. Bradley F. Boeve, Mayo Clinic, Department of Neurology, 200 First Street SW, Rochester, MN 55905; e-mail: bboeve{at}mayo.edu

Background: No data exist on whether the syndrome of amnestic mild cognitive impairment occurs in the oldest old, or if the relationships for functional status and neuropsychometric performance based on clinical diagnosis hold true in this age group.

Design/Methods: The authors performed comprehensive neurologic evaluations, neuropsychometric testing, and functional assessments on a sample of 90- to 100-year-old residents of Rochester, MN. Subjects were diagnosed as normal or with amnestic mild cognitive impairment (MCI) or dementia according to well-accepted criteria. Data on the following measures were collected and analyzed: Record of Independent Living (ROIL), Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Trailmaking Test (TMT), and modified version of the Free and Cued Selective Reminding Test (FCSRT).

Results: Data on 111 subjects (56 normal, 13 MCI, and 42 dementia) were analyzed. On the ROIL, functional capacity to carry out activities of daily living was worse for patients with dementia compared to patients with MCI and normal subjects, but did not differ between MCI and normal subjects. Scores on the MMSE, DRS, and TMT-A were worse in the dementia group compared to the normal group, and in the dementia group compared to MCI, but scores on these measures for normal subjects compared to patients with MCI were not different. Scores on the FCSRT and memory subtest of the DRS showed differences among all three groups.

Conclusion: In spite of the advanced age of the cohort, the relationship between cognitive and functional performance and clinical diagnosis follows patterns previously described in younger samples of normal subjects, subjects with amnestic mild cognitive impairment, and subjects with dementia.

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