Authors: Denis Larrivee.
The term mild cognitive impairment (MCI) has traditionally been used to refer to a transitional period between normal cognitive function and clinically probable Alzheimer’s disease (AD). Many studies report high reversion rates, however, with some 30% to 50% of those diagnosed with MCI reverting to “normal” cognition at subsequent follow-up. The detection of differentiable predisposing factors, reflected in the dichotomy between the annual reversion rate to normal cognition and the conversion rate to dementia, indicates that there are modifiable factors that may be contributing to cognitive decline. The clinical prospect for dementia and the presence of these predisposing factors have together made a strong case for early diagnosis and therapeutic intervention. Current efforts seek to identify tools capable of resolving the causal ambiguities inherent in MCI and to develop therapeutic avenues addressing such underlying aspects before long lasting and irreversible cognitive loss. This review explores three arenas for which there is especial promise for determining and modulating prognosis: in the diagnostic realm, novel neuroimaging procedures and biomarkers and, in the domain of therapy, network based non-invasive neurostimulation therapies. Particular examples include novel structural and dynamical MRI procedures for assessing connectivity and its alterations during disease, inflammation and miRNA markers, and non-invasive procedures for rehabilitating deteriorating brain functions. The advances occurring in these select areas indicate that the determination of MCI’s multi-etiology is a realistic goal that can ground prognosis assessment and therapeutic outcome.
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