Longitudinal neuropsychological evaluation allows diagnosis of MCI with less severe memory change

INTRODUCTION: We previously demonstrated that single-domain amnestic mild cognitive impairment (SDAm-MCI) detected through longitudinal neuropsychological testing in our research cohort is less severe than in clinically incident symptomatic individuals. This study aims to replicate and expand this work using a National Alzheimer's Coordinating Center dataset. METHODS: Participants were classified into two groups: those enrolled with normal cognition (Normal Enrollees) and those enrolled with SDAm-MCI (Amnestic Enrollees). Groups were compared at the time of diagnosis and on rates of cognitive decline post-diagnosis. RESULTS: At SDAm-MCI diagnosis, Normal Enrollees were 17% to 39% less impaired on memory tasks, after which the slope of change over time steepened compared to their pre-symptomatic change and was steeper than in Amnestic Enrollees. DISCUSSION: Incident MCI detected through longitudinal neuropsychological testing is initially milder but may progress more steeply than in clinically established MCI. Sensitive assessment of cognitive decline is essential for capturing early changes that are more likely to be amenable to therapeutic treatment. Highlights: Longitudinal cognitive evaluation detects symptomatic Alzheimer's disease earlier than mental status exams. At the time of diagnosis, converters were less impaired compared to initially symptomatic patients. Converters’ cognition declined more steeply than initially symptomatic patients. Sensitive cognitive tests are essential to capture early changes, given new disease-modifying therapies.