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  • CUR4: What are the symptoms and burden of Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI) for the patient at different stages of the disease?
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What are the symptoms and burden of Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI) for the patient at different stages of the disease?

Authors: Antonio Migliore, Tapani Keranen, Sinikka Sihvo

Internal reviewers: Kristian Lampe

The hallmark of MCI is cognitive decline that is greater than expected for an individual’s age and education level. The cognitive decline does not, however, interfere notably with activities of daily life {31}. Thus, the subjects with MCI have subjective cognitive complaints, which can be objectively verified, but no dementia. In most cases MCI is associated with isolated memory impairment (so called amnestic MCI) but also non-amnestic MCI (impairment in executive, language or visuospatial functions) may occur {63}. The impairment can be restricted to one cognitive domain or to multiple domains {63}.

In addition to its core features, i.e. cognitive symptoms, MCI can be associated with various behavioral symptoms. Systematic reviews of studies addressing neuropsychiatric manifestations in MCI have revealed that many patients with MCI have depression, anxiety, apathy and irritability {4} {58}. In fact, neuropsychiatric symptoms in MCI have similar pattern as in AD {58}. In caregivers and the family MCI may cause depression, stress, and burden {73}.

In AD dementia, there is a progressive decline in cognition. In mild dementia, the most prominent deficit is in the ability to recall new information. Other symptoms include impairment in language and visuospatial functions as well as involvement of attentional and executive domains {40}. Neuropsychiatric symptoms include depression, anxiety and irritability. Also sleep problems, apathy, delusions and paranoia may appear {40}. The patients may be able to do shopping, simple hobbies, bathing and dressing but they may have difficulties in complex financial arrangement {40}.

Patients with moderate AD dementia have impairment of all major cognitive domains. Also behavioral and psychic symptoms progress and frank hallucinations and delusions may appear. Behavior may involve socially inappropriate issues, and motor restless may occur. Behavioral and psychic symptoms may emerge as primary issues for caregivers {40}. Most of the ADL functions begin to be significantly affected e.g. cooking, cleaning and simple financial actions are impaired. The patients require daily help in dressing and daily hygiene, and eating may be involved. The patients may need 24 hour supervision {40}.

In severe AD dementia the patients may be disoriented to place and time and they may have difficulties in identifying close relatives. They may be able to conduct a casual conversation.  Functionally the patients are dependent of others for almost all of their daily care and they suffer from incontinence. At the latest stages of the disease the patients become bedridden. Psychic symptoms include worsening hallucinations, agitation, or on the other hand, progressive apathy {40}.

Personality changes may accompany AD. Increased neuroticism, decreased extraversion and conscientiousness, and stable or slightly decreased openness and agreeableness have been observed in patients with AD {69}. These symptoms may be associated with social dysfunction due to AD. Literature suggests that high neuroticism or low conscientiousness may be early signs of dementia of the Alzheimer type as well as the best predictors of subsequent personality change in dementia {69}.

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Migliore A et al. Result Card CUR4 In: Migliore A et al. Health Problem and Current Use of the Technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Use of Intravenous immunoglobulins for Alzeheimer’s disease including Mild Cognitive Impairment [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 31 October 2020]. Available from: http://corehta.info/ViewCover.aspx?id=267

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