COGNITIVE PRECLINICAL SYMPTOMS OF DEMENTIA:  HOW FAR BACK DOES IT GO?

Rhoda Au, Ph.D.
Associate Professor of Neurology, Boston University School of Medicine,
Director of Neuropsychology, Framingham Heart Study, Boston, MA, USA

Dementia is an insidious disease with gradual progression that reaches a threshold of impairment sufficient to trigger a diagnosis.  Effective treatment options remain elusive, in part, because detection occurs at stages where intervention can no longer be effective. Recent focus has been on diagnosis of mild cognitive impairment (MCI), a prodromal phase of dementia and specifically Alzheimer’s disease (AD), to increase potential for intervention and prevention. But research evidence suggests a preclinical phase of dementia, evidenced by poorer cognitive performance, which spans decades before overt symptoms emerge – an elongated pre-MCI period.  This course will first review this evidence.  Second, risk factors associated with these early markers will be presented.  And third, discussion will focus on how these findings should be impacting both clinical and research methods. Participation in this course should achieve the following learning objectives:  (1) understanding that progressive dementias, particularly AD, may be a life-course disease and management of mid-life health may help reduce later-life risk, and (2) development of strategies for assessment that can increase sensitivity for detecting subtle changes in cognition.