WORKUP of Minimal Cognitive Impairment

Lab Studies

No specific laboratory studies are indicated for MCI. Most practitioners perform at least a basic workup to rule out treatable conditions that may cause dementia, such as thyroid disease, cobalamin deficiency, and lues. These are not mandatory, however. A search for biological markers of MCI that may help distinguish among the many conditions that lead from this syndrome to full-blown dementia is ongoing. However, no unanimous agreement exists as of yet, and potentially useful markers such as functional and structural abnormalities found on imaging studies (eg, hippocampal atrophy, cerebral hypoperfusion) and putative biochemical markers (eg, apolipoprotein E epsilon 4 allele) remain controversial.

Imaging Studies

Brain imaging with computed tomography scanning or magnetic resonance imaging (preferably) is often performed in patients with MCI. No practice parameters have been recommended in this regard. However, findings indicate that hippocampal atrophy may correlate with MCI (Jack, 1999), although no established parameters exist to implement this correlation for the routine diagnosis and management of MCI.

Other Tests

Neuropsychological testing is probably useful in MCI, but this has not been conclusively demonstrated. While the value of such testing has been proven in AD and other dementias and is helpful to distinguish among dementing conditions, neither AD nor MCI can be diagnosed solely by using neuropsychological tests. The potential validity and utility of such tests will be determined in presently ongoing studies of large cohorts of patients with MCI. These ongoing studies will help define whether existing tests are useful in this context as well as in the design of new tests specifically adapted to patients with MCI.