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Mild cognitive impairment—a confused concept?

Nature Clinical Practice Neurology volume 3, pages 62–63 (2007)Cite this article

Debates about disease boundaries are not new, and they remain an essential aspect of the relationship between medicine and society. When does 'dis-ease' become disease? The establishment of the boundaries of Alzheimer's disease (AD) is a prominent illustration of such a diagnostic discourse. This debate is particularly salient given the aging of the world's population, expectations about the power of molecular neuroscience, the growing criticism of industry-led 'disease mongering' (i.e. the creation and extension of pathological boundaries for profit)1 and the limitations of current approaches in neuroethics—a subfield of bioethics that is failing to adequately challenge the hegemony of biomedical thinking.2

Mild cognitive impairment (MCI) is a decade-old, controversial label for a form of age-related intellectual decline that is said to exist on a continuum between normality and dementia.3,4,5,6 Unlike in dementia, activities of daily living are regarded as being intact or 'relatively' intact, but the question to ask is, relative to what? Physicians' knowledge about their patients' lifestyles is varied, and the importance of a patient's subjective complaint is a matter of debate. Psychological testing is said to be important for determining the degree of impairment, but again, what are the criteria that define MCI—test results that are one or two standard deviations below the performance of a reference population? And which reference population would that be? Research studies of the course and treatment of MCI demonstrate considerable variability in the application of such criteria and in clinical outcomes.7

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  1. Case Western Reserve University, University Memory and Aging Center, Integrative Studies, 12200 Fairhill Road, Room C357, Cleveland, OH 44120, USA whitehouse.peter@gmail.com

Authors and Affiliations

  1. PJ Whitehouse is Director of Integrative Studies at Case Western Reserve University, Cleveland, OH, USA.,

    Peter J Whitehouse

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Competing interests

The author has been a consultant for Eisai, Forest and sanofi-aventis and has received educational grants from Eisai and Forest.

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Whitehouse, P. Mild cognitive impairment—a confused concept?. Nat Rev Neurol 3, 62–63 (2007). https://doi.org/10.1038/ncpneuro0403

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