Actualités dans le domaine des troubles cognitifs: du diagnostic précoce au traitement

Our understanding of cognitive disorders with and with no dementia has been significantly improved for the last few years. "Mild cognitive impairment" (MCI) is defined by a deficit of a single cognitive domain, that is classically episodic memory, with intact activities of daily living (amnestic MCI). Other MCI subtypes have been characterized, not infrequently due to subcortical vascular disease. Longitudinal follow-up of patients with MCI showed that a substantial proportion of them convert to Alzheimer's disease (AD). Our challenge is to predict that particular patient. Brain neuroimaging such as MRI, FDG-PET or cerebrospinal fluid analysis may assist clinicians in this endeavour. A very recent functional neuroimaging technique using a ligand, 11 [PIB] or PIB with PET will not only allow us to differentiate prodromal dementias but also to sort out non-AD pathology. In the case of frontotemporal degeneration due to non-tau pathology, new progranulin mutations have been described. A more comprehensive understanding of this protein will allow us to better understand the regional selectivity and its link with social cognition that is a hallmark of frontotemporal degeneration. New treatments have emerged. Patients with Parkinson's disease with dementia could benefit from rivastigmine that also alleviated non-cognitive symptoms such as hallucinations and delusions. Memantine stabilized cognition and diminished agitation and aggressivity. Finally, atypical antipsychotics were not superior to placebo in the treatment of AD patients with agitation, aggression or psychosis in a large randomized-controlled trial.