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From Subjective Cognitive Decline to Mild Cognitive Impairment to Dementia: Clinical and Capacity Assessment Considerations


Mild cognitive impairment (MCI) is a prevalent condition with major implications for both society as a whole and on an individual level. The progression from MCI to dementia as part of the Alzheimer’s continuum has been widely studied. This progression is considered as an intermediate clinical stage from normal aging for many individuals before meeting full criteria for dementia. The identification of predictive factors continues to be studied with evidence suggesting that early prevention, rather than treatment per se, is the current most productive focus of research. However, comorbid old-age related conditions (e.g., vestibular dysfunction) and neuropsychiatric conditions such as depression can significantly confound identification of MCI in the absence of biomarkers and can also increase the risk of progression to dementia. Additionally, subjective cognitive decline (SCD) can be present in depression, which can complicate and obfuscate differential diagnosis. Notably, in the context of forensic psychological assessment, whether cognitive change is due to brain injury resulting from progressive multifaceted neurodegenerative condition or not has medico-legal implications. Moreover, the validity and reliability of collateral information also play a significant role in forensic settings. Hence, the neuropsychological assessment is uniquely placed to appropriately assess cognitive and psychological changes that can occur in the individual and impair functioning. Consequently, recommendations for best practice in the assessment of MCI in the older adult population are provided.

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Sepehry, A.A., Schultz, I.Z., Cohen, D.A. et al. From Subjective Cognitive Decline to Mild Cognitive Impairment to Dementia: Clinical and Capacity Assessment Considerations. Psychol. Inj. and Law (2022).

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  • Alzheimer’s
  • Capacity
  • Depression
  • Mild cognitive impairment
  • Neuropsychiatry
  • Neuropsychology
  • Subjective cognitive decline