The Mild Cognitive Impairment (MCI) in Searching for its Clinical Identity, Comment of the NEDICES Cohort Data
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Notice bibliographique
Résumé
Elderly cognitive decline is a well-known disorder that affects many people. One of the first medical definitions for this clinical reality was Kral’s “benign and malignant senescent forgetfulness”. After Kral, many authors proposed other entities of memory impairment or cognitive decline in the elderly: “Age-associated memory impairment”, “Agerelated memory decline”, “Ageing-associated cognitive decline”, Mild Cognitive Impairment (MCI) and “Cognitive Impairment Non-Dementia” (CIND) of the Canadian Study. And very recently, the DSM-V defined the elderly cognitive decline as a “Minor Neurocognitive Disorder”. By large, MCI had far more citations than any other predementia state in MEDLINE (more than 8,000 reviews in this medical database). This success in the medical literature is rather the expression of a controversy than a well-defined clinical disorder. In fact, its medical birth, near 30 years ago, was as a research entity that precludes dementia. The theoretical definition of MCI is quite clear (A cognitive decline with an increased dementia risk); the problem is the operational definition of this cognitive decline in many elderly that have produced, along the time many definitions and subtypes. In summary, MCI is defined as cognitive decline (of one or more cognitive domains, mainly memory) with normal or near normal functional activities of the patient, and obviously, no dementia. According to the type and extension of the affected cognitive domain, MCI has received several subtyping: Amnestic- only memory affected, non-amnestic- deficit in another cognitive domain different from the memory, such as executive capacities. Both of them could be shown alone or in combination (only amnestic MCI, only non-amnestic, or amnestic o non-amnestic plus other cognitive domain affected. There are several well-known characteristics of this entity. First, it is prevalent in the elderly, more prevalent (about 10-15%) that the dementia states (5-10%). Obviously, in both conditions, its prevalence oscillates with the operational definitions used and with the population demographic characteristics studied: age, sex and education. Second, MCI involves an increased risk of dementia and mortality in relation to the normal cognition elders. Third, it is an unstable disorder, many MCI cases do not evolve to dementia, and many others change to normal cognition in a period of 2-3 years. Fourth, MCI is a heterogeneous entity with many risk factors and aetiologies; it is not always the predementia state of the main neurodegenerative disorders of the elderly: Alzheimer disease (AD), Parkinson disease (PD) and others; cerebral vascular diseases, depression and elderly co-morbidities underpinning many MCI cases. From an epidemiological point of view, it is interesting to comment the MCI definition in three different scenarios: the clinical setting, the population-based surveys, and the trial studies because in these three scenarios, MCI had different characteristics and evolution.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle