OscarLopez, Neurologist, University of Pittsburgh Medical Center
Melissa J.Armstrong, Neurologist, University of Florida College of Medicine
Thomas S.D.Getchius, Manager, Heart Rhythm Society
MaryGanguli, Psychiatrist, Department of Psychiatry, University of Pittsburgh
DavidGloss, Neurologist, Charleston Area Medical Center Neurology
Gary S.Gronseth, Neurologist, University of Kansas Medical Center
DanielMarson, Clinical Neuropsychologist, University of Alabama at Birmingham
TamaraPringsheim, Neurologist, Cumming School of Medicine, University of Calgary
Gregory S.Day, Neurologist, Knight Alzheimer Disease Research Center, Washington University School of Medicine
MarkSager, Geriatrician, School of Medicine and Public Health, University of Wisconsin
JamesStevens, Neurologist, Fort Wayne Neurological Center
Alexander D.Rae-Grant, Neurologist, Cleveland Clinic Neurological Institute at Lakewood Hospital
Submitted January 29, 2018
We thank Drs. Gang Wang and Hai-lun Cui for the comment on the recently published mild cognitive impairment (MCI) guideline. [1] We agree that there is a great deal of interest in predicting the patients with MCI who will revert to normal cognition, remain stable, or progress to dementia due to Alzheimer disease or other pathologies, whether using subtle differences in clinical presentation or emerging biomarkers. When participants are followed longitudinally, the reversion rates are substantially lower. [2,3] With regard to the suggested treatment studies, the 3 offered references were published after the time of the guideline’s updated systematic review. [4-6] In reviewing these publications, we note that the publications did not focus on patients with MCI, an inclusion criterion for the therapeutic studies included in the guideline. We also agree with the uncertainty regarding the current role of biomarkers. This is reflected in recommendations A7a and A7b. [1] Recommendation A7a states that clinicians should counsel patients and families asking about biomarkers that there are no accepted biomarkers at this time. For interested patients, clinicians may discuss the option of biomarker research (recommendation A7b).
1. Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2018;90:126-135.
2. Roberts RO, Knopman DS, Mielke MM, et al. Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal. Neurology 2014;82:317–325.
3. Lopez OL, Becker JT, Chang YF, et al. Incidence of mild cognitive impairment in the Pittsburgh Cardiovascular Health Study-Cognition Study. Neurology 2012;79:1599–1606.
4. Tao J, Chen X, Egorova N, et al. Tai Chi Chuan and Baduanjin practice modulates functional connectivity of the cognitive control network in older adults. Sci Rep 2017;7:41581.
5. Tao J, Liu J, Liu W, et al. Tai Chi Chuan and Baduanjin Increase Grey Matter Volume in Older Adults: A Brain Imaging Study. J Alzheimers Dis 2017;60:389-400.
6. Brasure M, Desai P, Davila H, et al. Physical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia: A Systematic Review. Ann Intern Med 2018;168:30-38.
We thank Drs. Gang Wang and Hai-lun Cui for the comment on the recently published mild cognitive impairment (MCI) guideline. [1] We agree that there is a great deal of interest in predicting the patients with MCI who will revert to normal cognition, remain stable, or progress to dementia due to Alzheimer disease or other pathologies, whether using subtle differences in clinical presentation or emerging biomarkers. When participants are followed longitudinally, the reversion rates are substantially lower. [2,3] With regard to the suggested treatment studies, the 3 offered references were published after the time of the guideline’s updated systematic review. [4-6] In reviewing these publications, we note that the publications did not focus on patients with MCI, an inclusion criterion for the therapeutic studies included in the guideline. We also agree with the uncertainty regarding the current role of biomarkers. This is reflected in recommendations A7a and A7b. [1] Recommendation A7a states that clinicians should counsel patients and families asking about biomarkers that there are no accepted biomarkers at this time. For interested patients, clinicians may discuss the option of biomarker research (recommendation A7b).
1. Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2018;90:126-135.
2. Roberts RO, Knopman DS, Mielke MM, et al. Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal. Neurology 2014;82:317–325.
3. Lopez OL, Becker JT, Chang YF, et al. Incidence of mild cognitive impairment in the Pittsburgh Cardiovascular Health Study-Cognition Study. Neurology 2012;79:1599–1606.
4. Tao J, Chen X, Egorova N, et al. Tai Chi Chuan and Baduanjin practice modulates functional connectivity of the cognitive control network in older adults. Sci Rep 2017;7:41581.
5. Tao J, Liu J, Liu W, et al. Tai Chi Chuan and Baduanjin Increase Grey Matter Volume in Older Adults: A Brain Imaging Study. J Alzheimers Dis 2017;60:389-400.
6. Brasure M, Desai P, Davila H, et al. Physical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia: A Systematic Review. Ann Intern Med 2018;168:30-38.
For disclosures, please contact the editorial office at journal@neurology.org.