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Longitudinal profiling of mild cognitive impairment subtypes

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Klekociuk, S (2013) Longitudinal profiling of mild cognitive impairment subtypes. PhD thesis, University of Tasmania.

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Abstract

Mild Cognitive Impairment (MCI) was originally conceptualized as a condition that
manifested prior to the onset of clinical dementia, particularly Alzheimer’s disease. However,
longitudinal studies show that MCI has an unstable course and may lead to various outcomes
including dementia, but also stability of cognitive deficits or recovery to age appropriate
levels of functioning. As a result, the status of MCI as a genuine diagnostic entity remains
questionable. The aim of the present thesis was to examine the validity of the MCI concept
by tracking groups of individuals classified into one of the MCI subtypes and to monitor their
neuropsychological profiles over time. To avoid previous criticisms of circularity,
participants were classified as MCI on a neuropsychological test battery and then reassessed
longitudinally using an alternate battery of neuropsychological tests. At each stage of testing,
participants were assessed on a comprehensive neuropsychological test battery tapping the
cognitive domains implicated in MCI. Findings from this thesis indicate that multiple domain
amnestic MCI may be the most valid subtype of MCI due to consistently poor performance
over time on a range of neuropsychological measures. Results also demonstrate that those
who are likely to remain on the MCI spectrum can be differentiated from healthy older adults
using reliable and valid measures of sustained attention, semantic memory, verbal episodic
memory, visual and verbal working memory, selective attention and strategy use. Despite
these findings, evidence from this thesis indicates that existing MCI clinical criteria lack
sufficient sensitivity and specificity. Although the concept of MCI remains useful, it cannot
be considered a clinical diagnostic entity. Future research should prioritize the observation of
those presenting with a multiple domain amnestic profile as these individuals may have the
poorest prognosis. Further, studies must utilize comprehensive testing protocols to increase
the sensitivity and specificity of identifying those with genuine subclinical impairments.

Item Type: Thesis (PhD)
Keywords: mild cognitive impairment, Aging, Alzheimers disease, Neuropsychology
Copyright Holders: The Author
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Date Deposited: 22 Apr 2015 06:24
Last Modified: 15 Sep 2017 01:06
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