A 65-year-old woman recently diagnosed with mild cognitive impairment seeks advice about prevention of dementia. The patient has glaucoma, osteoarthritis, type 2 diabetes mellitus, and osteoporosis. She lives alone and performs all activities of daily living independently. The patient is troubled by her memory impairment but compensates by writing things down and making lists. She has no depression and scores 25/30 on the Mini-Mental Status Examination. The patient's sister developed dementia at age 69 and was recently admitted to a long-term care facility. Her aunt suffered from dementia and died of pneumonia at age 78.
Blood pressure is 122/70 mm Hg and pulse is 77/min. BMI is 26 kg/m². General physical examination, including neurologic examination, shows no abnormalities.
Complete blood count, comprehensive metabolic panel, serum thyroid-stimulating hormone, and vitamin B₁₂ level are all within normal limits.
Which of the following is the most appropriate recommendation for this patient?

Question

Quizplus · Accepted Answer

Patients with mild cognitive impairment (MCI) are at increased risk for dementia, with an estimated risk of progression to dementia of 10% per year. There is no FDA-approved pharmacologic treatment to recommend for MCI. Despite multiple trials of pharmacologic agents and supplements, including but not limited to cholinesterase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), antioxidant vitamins, and ginkgo biloba, no supplement or medication has demonstrated efficacy for prevention of cognitive decline or incident dementia in patients with MCI. However, exercise should be recommended as studies have reported some positive effects of physical exercise on cognition, mainly on global cognition, executive function, attention, and delayed recall. Several studies also support the claim that cognitively stimulating activities as well as active social engagement can slow progression to Alzheimer disease (AD) in at-risk patients. In contrast to unproven pharmacotherapy, these interventions also do no harm. Vascular risk factors should also be targeted to prevent vascular events or stroke. (Choices A, B, and C) There is no consistent evidence for the benefit of NSAIDs or cholinesterase inhibitors in the treatment of MCI or in preventing progression to dementia. Memantine is an N-methyl-D-aspartate-receptor antagonist that is indicated in the treatment of moderate to severe AD. (Choice E) There is no consistent evidence that vitamin E or other antioxidant vitamins (eg, vitamin C, beta-Carotene, selenium) can prevent cognitive decline or dementia in MCI. There is some evidence, however, that vitamin E can slow disease progression in patients with established mild to moderate AD. Educational objective: There is no pharmacotherapy with established efficacy for mild cognitive impairment. Higher levels of physical exercise, cognitive activities, active social interactions, and control of cardiovascular risk factors appear to be associated with a decrease in the rate of decline in cognitive impairment in patients at risk for dementia. __________ References: Effect of physical exercise on cognitive performance in older adults with mild cognitive impairment or dementia: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/25171577) The diagnosis and management of mild cognitive impairment: a clinical review. (http://www.ncbi.nlm.nih.gov/pubmed/25514304) Cholinesterase inhibitors for mild cognitive impairment. (http://www.ncbi.nlm.nih.gov/pubmed/22972133)

A 65-Year-Old Woman Recently Diagnosed with Mild Cognitive Impairment Seeks