Klinische und neuropsychologisch-operationalisierte Kriterien zur Früherkennung eines Mild Cognitive Impairment: Eine Übersicht und kritische Einordnung

Zusammenfassung

Seit seiner Einführung im Jahr 1999 hat sich der Begriff des Mild Cognitive Impairment (MCI) als klinisches Syndrom in der wissenschaftlichen und klinischen Praxis etabliert. Technische und wissenschaftliche Fortschritte machten eine regelmäßige Aktualisierung von Forschungskriterien erforderlich. In der Entwicklung kam es so zu einer stärker biologischen Definition und dem Einbezug von Biomarker-basierten Kriterien, während die klinischen Kernkriterien im Wesentlichen unverändert blieben. Das klinische MCI-Kernkriterium zu objektivierbaren kognitiven Defiziten erlaubt eine konkrete Operationalisierung und hat wiederum zur Entwicklung verschiedener neuropsychologisch-operationalisierter Kriterien geführt. Weitere Ansätze, die sensitiver für erste kognitive Veränderungen sein könnten oder auch stärker das Kriterium des kognitiven Abbaus berücksichtigen, könnten künftig ebenfalls dafür genutzt werden. Dabei müssen für die Anwendung neuropsychologisch-operationalisierter Kriterien bestimmte Voraussetzungen erfüllt sein, wie die Erfassung relevanter kognitiver Domänen mit angemessen normierten Testverfahren in einem ausreichenden Umfang. Eine standardisierte und konsistente Nutzung dieser Kriterien könnte die hohe Variation in MCI-Prävalenzraten reduzieren sowie prognostische Einschätzungen und Behandlungsentscheidungen in der klinischen Routine angleichen. Erhebungen zum Ist-Zustand in deutschen Gedächtnisambulanzen zeigen, dass perspektivisch die Möglichkeit einer einrichtungsübergreifenden Verständigung auf ein Kriterienset i.S. einer Harmonisierung möglich wäre. Dennoch bliebe bei einer Festlegung auf eine Operationalisierung weiterhin abschließend das klinische Urteil mit angemessener Würdigung individueller Einflussfaktoren ausschlaggebend für eine MCI-Diagnose. Die vorliegende Arbeit liefert einen Überblick und Einordnung zu klinischen und neuropsychologisch-operationalisierten Kriterien, deren Herausforderungen und neuen Entwicklungen, um erste kognitive Veränderungen frühzeitig und adäquat zu detektieren.

Abstract

Since its introduction in 1999, the clinical syndrome Mild Cognitive Impairment (MCI) has been established in scientific and clinical practice. Technical and scientific advances made it necessary to regularly update research criteria, resulting in a shift to a more biological definition and biomarker-based criteria, while clinical core criteria remained essentially unchanged. The cognitive core criterion (objective evidence of cognitive impairment) allows concrete operationalization and has, in turn, led to the development of various neuropsychological criteria. Approaches more sensitive to early cognitive changes or taking greater account of cognitive decline may also be further elaborated for their future use. In general, certain conditions must be met for the use of neuropsychological criteria, such as the assessment of relevant cognitive domains with appropriately standardized test procedures to a sufficient extent. Standardized and consistent criteria use could reduce the high rates of variation observed in MCI prevalence rates and could help harmonizing prognostic evaluations and treatment decisions in routine clinical practice. Surveys of the status quo in German memory clinics suggest that there is a basis to possibly reach consensus on a set of criteria across institutions. Despite a potential commitment to specific neuropsychological criteria, clinical judgment appropriately considering individual factors would remain decisive for an MCI diagnosis and thus leaving existing MCI clinical core criteria untouched. The present work provides an overview on clinical and neuropsychological MCI criteria, discusses their challenges and future perspectives to timely and adequately detect first meaningful cognitive changes.

Schlüsselwörter

leichte kognitive Störung - Demenz - Neuropsychologie - Diagnostik - Gedächtnisambulanz - Standards

Keywords

mild cognitive impairment - dementia - neuropsychology - diagnostics - memory clinic - standards

Publikationsverlauf

Eingereicht: 01. August 2025

Angenommen nach Revision: 18. September 2025

Artikel online veröffentlicht:
06. November 2025

• Literatur

• 1 DGN e. V. & DGPPN e. V., Hrsg. S3-Leitlinie Demenzen, Version 5.1. 2025;
• 2 Roberts R, Knopman DS. Classification and Epidemiology of MCI. Clinics in Geriatric Medicine 2013; 29: 753-772
• 3 Petersen RC, Caracciolo B, Brayne C. et al. Mild cognitive impairment: a concept in evolution. J Intern Med 2014; 275: 214-228
• 4 Casagrande M, Marselli G, Agostini F. et al. The complex burden of determining prevalence rates of mild cognitive impairment: A systematic review. Front Psychiatry 2022; 13: 960648
• 5 Roberts JS, Karlawish JH, Uhlmann WR. et al. Mild cognitive impairment in clinical care: A survey of American Academy of Neurology members. Neurology 2010; 75: 425-431
• 6 Benson GS, Bartels C, Stamatis F. et al. The Use and Understanding of Mild Cognitive Impairment in Routine Specialist Care: A Survey Among German Memory Clinics. Geriatrics 2025; 10: 21
• 7 Alzola P, Carnero C, Bermejo-Pareja F. et al. Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights. JCM 2024; 13: 3442
• 8 Gauthier S, Reisberg B, Zaudig M. et al. Mild cognitive impairment. The Lancet 2006; 367: 1262-1270
• 9 Stokin GB, Krell-Roesch J, Petersen RC. et al. Mild Neurocognitive Disorder: An Old Wine in a New Bottle. Harvard Review of Psychiatry 2015; 23: 368-376
• 10 Mariani E, Monastero R, Mecocci P. Mild Cognitive Impairment: A Systematic Review. JAD 2007; 12: 23-35
• 11 Reisberg B, Ferris SH, De Leon MJ. et al. Stage-specific behavioral, cognitive, and in vivo changes in community residing subjects with age-associated memory impairment and primary degenerative dementia of the Alzheimer type. Drug Development Research 1988; 15: 101-114
• 12 Petersen RC, Smith GE, Waring SC. et al. Mild Cognitive Impairment: Clinical Characterization and Outcome. Arch Neurol 1999; 56: 303
• 13 Petersen RC, Doody R, Kurz A. et al. Current Concepts in Mild Cognitive Impairment. Arch Neurol 2001; 58: 1985
• 14 Winblad B, Palmer K, Kivipelto M. et al. Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine 2004; 256: 240-246
• 15 Petersen RC. Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine 2004; 256: 183-194
• 16 Dubois B, Feldman HH, Jacova C. et al. Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS–ADRDA criteria. The Lancet Neurology 2007; 6: 734-746
• 17 Albert MS, DeKosky ST, Dickson D. et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia 2011; 7: 270-279
• 18 Dubois B, Feldman HH, Jacova C. et al. Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. The Lancet Neurology 2014; 13: 614-629
• 19 Jack CR, Bennett DA, Blennow K. et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease. Alzheimer’s & Dementia 2018; 14: 535-562
• 20 Jack CR, Andrews JS, Beach TG. et al. Revised criteria for diagnosis and staging of Alzheimer’s disease: Alzheimer’s Association Workgroup. Alzheimer’s & Dementia 2024; 20: 5143-5169
• 21 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; 2013
• 22 Weltgesundheitsorganisation (WHO). Internationale Klassifikation der Krankheiten, Elfte Revision (ICD-11). Kap 6: Psychische, Verhaltens- oder neuroentwicklungsbedingte Störungen 2019; Im Internet: https://icd.who.int/dev11/f/en#!/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F195531803 Stand: 11.07.2025
• 23 Jessen F, Frölich L. ICD-11: Neurokognitive Störungen. Fortschr Neurol Psychiatr 2018; 86: 172-177
• 24 Weltgesundheitsorganisation (WHO). Internationale Klassifikation der Krankheiten, Elfte Revision (ICD-11). 2019; Im Internet: https://icd.who.int/browse11 Stand: 10.07.2025
• 25 Dilling H, Freyberger HJ. Taschenführer zur ICD-10-Klassifikation psychischer Störungen (6. Auflage). Bern: Hogrefe AG; 2012
• 26 World Health Organization (WHO). ICD-10 : international statistical classification of diseases and related health problems: tenth revision, 2nd ed. World Health Organization; 2024. Im Internet: https://iris.who.int/handle/10665/42980 Stand: 13.07.2025
• 27 Jessen F, Amariglio RE, Van Boxtel M. et al. A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimer’s & Dementia 2014; 10: 844-852
• 28 Levy R. Aging-associated cognitive decline. Working Party of the International Psychogeriatric Association in collaboration with the World Health Organization. Int Psychogeriatr 1994; 6: 63-68
• 29 Vuoksimaa E, for the Alzheimer’s Disease Neuroimaging Initiative, McEvoy LK, et al. Modifying the minimum criteria for diagnosing amnestic MCI to improve prediction of brain atrophy and progression to Alzheimer’s disease. Brain Imaging and Behavior 2020; 14: 787-796
• 30 Chandler MJ, Lacritz LH, Hynan LS. et al. A total score for the CERAD neuropsychological battery. Neurology 2005; 65: 102-106
• 31 Ehrensperger MM, Berres M, Taylor KI. et al. Early detection of Alzheimer’s disease with a total score of the German CERAD. J Int Neuropsychol Soc 2010; 16: 910-920
• 32 Polcher A, Wolfsgruber S, Peters O. et al. A Comparison of Operational Definitions for Mild Cognitive Impairment. Journal of Alzheimer’s Disease 2022; 88: 1663-1678
• 33 Moms JC, Heyman A, Mohs RC. et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assesment of Alzheimer’s disease. Neurology 1989; 39: 1159-1159
• 34 McKhann G, Drachman D, Folstein M. et al. Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34: 939-939
• 35 Mistridis P, Egli SC, Iverson GL. et al. Considering the base rates of low performance in cognitively healthy older adults improves the accuracy to identify neurocognitive impairment with the Consortium to Establish a Registry for Alzheimer’s Disease-Neuropsychological Assessment Battery (CERAD-NAB). Eur Arch Psychiatry Clin Neurosci 2015; 265: 407-417
• 36 Oltra-Cucarella J, Sánchez-SanSegundo M, Rubio-Aparicio M. et al. The Association Between the Number of Neuropsychological Measures and the Base Rate of Low Scores. Assessment 2021; 28: 955-963
• 37 Jak AJ, Bondi MW, Delano-Wood L. et al. Quantification of Five Neuropsychological Approaches to Defining Mild Cognitive Impairment. The American Journal of Geriatric Psychiatry 2009; 17: 368-375
• 38 Bondi MW, Edmonds EC, Jak AJ. et al. Neuropsychological Criteria for Mild Cognitive Impairment Improves Diagnostic Precision, Biomarker Associations, and Progression Rates. JAD 2014; 42: 275-289
• 39 Jak AJ, Preis SR, Beiser AS. et al. Neuropsychological Criteria for Mild Cognitive Impairment and Dementia Risk in the Framingham Heart Study. J Int Neuropsychol Soc 2016; 22: 937-943
• 40 Molinuevo JL, Rabin LA, Amariglio R. et al. Implementation of subjective cognitive decline criteria in research studies. Alzheimer’s & Dementia 2017; 13: 296-311
• 41 Schild A-K, Meiberth D, Frommann I. et al. Neuropsychologische Demenzdiagnostik: Umfrage zum klinischen Standardvorgehen im Rahmen des Deutschen Netzwerks Gedächtnisambulanzen e.V. Zeitschrift für Neuropsychologie 2023; 34: 183-202
• 42 Bartels C, Meiberth D, Frommann I. et al. (in press). Anwendung neuropsychologischer Kriterien zur syndromalen Diagnose eines Mild Cognitive Impairment (MCI): Umfrage zum Status quo unter Gedächtnisambulanzen des DNG e.V.. Zeitschrift für Neuropsychologie
• 43 Lezak MD, Howieson DB, Bigler ED. et al. Neuropsychological Assessment (5th ed.). Oxford University Press; 2012
• 44 Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: Administration, norms, and commentary. Oxford University Press; 2006
• 45 Ozer S, Young J, Champ C. et al. A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment: A systematic review of the DTA of brief cognitive tests to detect aMCI. Int J Geriatr Psychiatry 2016; 31: 1139-1150
• 46 Lonie JA, Tierney KM, Ebmeier KP. Screening for mild cognitive impairment: a systematic review. Int J Geriat Psychiatry 2009; 24: 902-915
• 47 Petrazzuoli F, Vestberg S, Midlöv P. et al. Brief Cognitive Tests Used in Primary Care Cannot Accurately Differentiate Mild Cognitive Impairment from Subjective Cognitive Decline. Journal of Alzheimer’s Disease 2020; 75: 1191-1201
• 48 Weisenbach SL, Boore LA, Kales HC. Depression and Cognitive Impairment in Older Adults. Curr Psychiatry Rep 2012; 14: 280-288
• 49 Gold M, Amatniek J, Carrillo MC. et al. Digital technologies as biomarkers, clinical outcomes assessment, and recruitment tools in Alzheimer’s disease clinical trials. A&D Transl Res & Clin Interv 2018; 4: 234-242
• 50 Bradfield NI. Mild Cognitive Impairment: Diagnosis and Subtypes. Clin EEG Neurosci 2023; 54: 4-11
• 51 Edmonds EC, Delano-Wood L, Jak AJ. et al. “Missed” Mild Cognitive Impairment: High False-Negative Error Rate Based on Conventional Diagnostic Criteria. JAD 2016; 52: 685-691
• 52 Shen X, Kuo K, Yang Y. et al. Subtle cognitive impairment as a marker of Alzheimer’s pathologies and clinical progression in cognitively normal individuals. Alz & Dem Diag Ass & Dis Mo 2021; 13
• 53 Thomas KR, Edmonds EC. Objective Criteria for Subtle Cognitive Decline in Aging and Preclinical Alzheimer Disease: A Systematic Review. Neurology 2025; 104
• 54 Giannakopoulos P, Montandon M-L, Rodriguez C. et al. Prediction of Subtle Cognitive Decline in Normal Aging: Added Value of Quantitative MRI and PET Imaging. Front Aging Neurosci 2021; 13
• 55 Weinstein AM, Fang F, Chang C-CH. et al. Multimodal neuroimaging biomarkers and subtle cognitive decline in a population-based cohort without dementia. Journal of Alzheimer’s Disease 2025; 103: 570-581
• 56 Stark M, Wolfsgruber S, Kleineidam L. et al. Relevance of Minor Neuropsychological Deficits in Patients With Subjective Cognitive Decline. Neurology 2023; 101
• 57 Edmonds EC, Delano-Wood L, Galasko DR. et al. Subtle Cognitive Decline and Biomarker Staging in Preclinical Alzheimer’s Disease. J Alzheimers Dis 2015; 47: 231-242
• 58 Thomas KR, Edmonds EC, Eppig J. et al. Using Neuropsychological Process Scores to Identify Subtle Cognitive Decline and Predict Progression to Mild Cognitive Impairment. Journal of Alzheimer’s Disease 2018; 64: 195-204
• 59 Munro CE, Boyle R, Chen X. et al. Recent contributions to the field of subjective cognitive decline in aging: A literature review. Alz & Dem Diag Ass & Dis Mo 2023; 15
• 60 Jutten RJ, Thompson L, Sikkes SAM. et al. A Neuropsychological Perspective on Defining Cognitive Impairment in the Clinical Study of Alzheimer’s Disease: Towards a More Continuous Approach. JAD 2022; 86: 511-524
• 61 Darby D, Maruff P, Collie A. et al. Mild cognitive impairment can be detected by multiple assessments in a single day. Neurology 2002; 59: 1042-1046
• 62 Berron D, Glanz W, Clark L. et al. A remote digital memory composite to detect cognitive impairment in memory clinic samples in unsupervised settings using mobile devices. npj Digit Med 2024; 7
• 63 Rodini M, Bonarota S, Serra L. et al. Could Accelerated Long-Term Forgetting Be a Feature of the Higher Rate of Memory Complaints Associated with Subjective Cognitive Decline? An Exploratory Study. Journal of Alzheimer’s Disease 2024; 100: 1165-1182
• 64 Lu K, Baker J, Nicholas JM. et al. Associations between accelerated forgetting, amyloid deposition and brain atrophy in older adults. Brain 2025; 148: 1302-1315
• 65 De Simone MS, Rodini M, De Tollis M. et al. The diagnostic usefulness of experimental memory tasks for detecting subjective cognitive decline: Preliminary results in an Italian sample. Neuropsychology 2023; 37: 636-649