Department of Psychiatry and Psychotherapy, Technische Universität München, Germany.
Ageing Res Rev. 2010 Jul;9(3):280-8. doi: 10.1016/j.arr.2010.01.003. Epub 2010 Jan 28.
Mild cognitive impairment (MCI) is a heterogeneous condition with cognitive changes between normal aging and dementia. Some forms of MCI are regarded as potential preclinical forms of dementia. The control of treatable somatic risk factors is of great relevance in patients with MCI, particularly as there is insufficient evidence for the efficacy of interventions targeting neurodegenerative processes, as used in manifest dementia. The etiology of MCI is varied including cerebrovascular risk factors and is also associated with metabolic and endocrine factors. Chronic kidney disease is a newly identified and independent risk factor for MCI. Testosterone substitution is useful if a low testosterone level is present but general screening for testosterone deficiency is not yet recommended. A relationship between MCI and vitamin D or subclinical thyroid dysfunction may exist, but the value of substitution is doubtful and requires large randomized placebo-controlled trials. Although an association between vitamin B12 deficiency or hyperhomocysteinemia and MCI is present, substitution of vitamin B12 or folate does not appear to prevent cognitive decline. Estrogen-only hormone replacement therapy may be considered only in younger postmenopausal women, but may have detrimental effects on cognitive function in older postmenopausal women. Other less familiar or unknown risk factors contributing to cognitive dysfunction should be identified as they are a potential target of prevention or intervention of MCI or dementia.
轻度认知障碍 (MCI) 是一种异质性疾病，其认知变化介于正常衰老和痴呆之间。某些形式的 MCI 被认为是痴呆的潜在临床前形式。在 MCI 患者中，控制可治疗的躯体风险因素非常重要，特别是因为针对神经退行性过程的干预措施的疗效证据不足，而这些干预措施在明显的痴呆中使用。MCI 的病因多种多样，包括脑血管危险因素，也与代谢和内分泌因素有关。慢性肾脏病是 MCI 的一个新确定的独立危险因素。如果存在低睾酮水平，睾酮替代治疗是有用的，但目前还不建议进行一般的睾酮缺乏筛查。MCI 与维生素 D 或亚临床甲状腺功能减退之间可能存在关联，但替代治疗的价值值得怀疑，需要进行大型随机安慰剂对照试验。虽然维生素 B12 缺乏或高同型半胱氨酸血症与 MCI 之间存在关联，但补充维生素 B12 或叶酸似乎并不能预防认知能力下降。仅在年轻的绝经后妇女中可以考虑使用雌激素单独激素替代疗法，但在老年绝经后妇女中可能对认知功能有不利影响。应该确定其他不太熟悉或未知的导致认知功能障碍的风险因素，因为它们是预防或干预 MCI 或痴呆的潜在目标。
