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To the Editor: In their Commentary, Dr Brayne and colleagues¹ raise many critical issues regarding the need to identify effective methods to screen for dementia. We suggest that this include detection of the mild cognitive impairment (MCI) syndrome, where there is objective decline in cognitive functioning. Longitudinal clinical studies indicate that participants with amnestic MCI have a substantially increased rate of progression to clinically probable Alzheimer disease.²

As the authors point out, it is extremely unusual to find reversible causes of dementia. However, many potentially reversible factors can contribute to MCI with cognitive performance that is worse than expected as a result of aging alone, such as medical illness, depression, medication adverse effects, or cardiovascular factors. Many of these may be amenable to intervention if a patient screens positive on routine testing. Moreover, nonpharmacological therapies such as psychosocial interventions have been reported as effective in improving cognitive performance in aging . . . [Full Text of this Article]

Michael S. Rafii, MD, PhD
mrafii@ucsd.edu

Douglas Galasko, MD
University of California, San Diego
La Jolla