Futures directions This author believes that a fundamental rethinking of MCI is necessary. He doubts that more conferences alone will lead to consensus, since there have been many such conferences and the differences of opinion remain. At the 9th Conference on Alzheimer’s Disease and Related Disorders in selleckchem Philadelphia, Pa, in July 2004, this author received the impression of a growing split between the USA and Europe. In fact, within the USA, the original
Mayo Clinic concept of the MCI (perhaps Inhibitors,research,lifescience,medical to be renamed Petersen’s syndrome) is still meeting resistance. The main issue that remains is the need to address more seriously the continuum of aging. Of course, such a reconsideration of the categories of age-related cognitive impairment would have implications for AD as well.30 Despite the work in genetics and neuroimaging, we are having a harder Inhibitors,research,lifescience,medical time differentiating the various
types of dementia from each other.11 This is most likely explained by Inhibitors,research,lifescience,medical the fact that the process of brain aging affects individuals in many different ways and our attempts to assign dementias into discrete categories are failing because of the overlap in biologies at work in our brain.31 Vascular and neurodegenerative processes interact. Neuronal loss occurs in multiple different systems to different degrees creating a wide spectrum of cognitive, affective, and motor symptoms. Is there a regulatory implication for the development of medications Inhibitors,research,lifescience,medical to treat cognitive impairment? As I have suggested previously,1 it may be possible to treat cognitive impairment as a nonspecific symptom rather than a feature of different discrete conditions. The biological substrate for such a claim is that overall loss occurs continuously in various brain nuclei as we age. For example,
loss of cells Inhibitors,research,lifescience,medical in the cholinergic basal forebrain occurs in a variety of dementias and with normal aging. Cholinesterase inhibitors appear to work, albeit in modest ways, in a variety of dementias characterized by cholinergic pathology, including not only AD, but also Parkinson’s disease, vascular dementia, STK38 and other overlapping conditions. Could we consider cognitive impairment like pain? Perhaps an analogy closer to home is the treatment of agitation in dementia. Psychosis, which may be considered a discrete category, exists in a variety of conditions; agitation occurs on a continuum. Drugs to treat agitation are being developed and submitted for approval based on finding positive effects in three or more conditions, like dementia and mental retardation.