Editing Dementia (section)

====Prodromal====
Pre-dementia states considered as prodromal are [[mild cognitive impairment]] (MCI) and ''mild behavioral impairment'' (MBI).<ref name=Sherman>{{cite journal |vauthors=Sherman C, Liu CS, Herrmann N, Lanctôt KL |title=Prevalence, neurobiology, and treatments for apathy in prodromal dementia |journal=Int Psychogeriatr |volume=30 |issue=2 |pages=177–184 |date=February 2018 |pmid=28416030 |doi=10.1017/S1041610217000527 |s2cid=46788701 |doi-access=free }}</ref><ref name="Breton">{{cite journal | vauthors = Breton A, Casey D, Arnaoutoglou NA | title = Cognitive tests for the detection of mild cognitive impairment (MCI), the prodromal stage of dementia: Meta-analysis of diagnostic accuracy studies | journal = International Journal of Geriatric Psychiatry | volume = 34 | issue = 2 | pages = 233–242 | date = February 2019 | pmid = 30370616 | doi = 10.1002/gps.5016 | s2cid = 53097138 }}</ref><ref name="Bateman">{{cite journal |vauthors=Bateman DR, Gill S, Hu S, Foster ED, Ruthirakuhan MT, Sellek AF, Mortby ME, Matušková V, Ng KP, Tarawneh RM, Freund-Levi Y, Kumar S, Gauthier S, Rosenberg PB, Ferreira de Oliveira F, Devanand DP, Ballard C, Ismail Z |title=Agitation and impulsivity in mid and late life as possible risk markers for incident dementia |journal= Alzheimer's & Dementia: Translational Research & Clinical Interventions|volume=6 |issue=1 |page=e12016 |date=2020 |pmid=32995467 |pmc=7507499 |doi=10.1002/trc2.12016}}</ref> Signs and symptoms at the prodromal stage may be subtle, and the early signs often become apparent only in hindsight.<ref name="ADCS">{{cite journal |vauthors=Atri A |title=The Alzheimer's Disease Clinical Spectrum: Diagnosis and Management |journal=Med Clin North Am |volume=103 |issue=2 |pages=263–293 |date=March 2019 |pmid=30704681 |doi=10.1016/j.mcna.2018.10.009 |doi-access=free }}</ref> Of those diagnosed with MCI, 70% later progress to dementia.<ref name="Memory Loss" /> In mild cognitive impairment, changes in the person's brain have been happening for a long time, but the symptoms are just beginning to appear. These problems, however, are not severe enough to affect daily function. If and when they do, the diagnosis becomes dementia. The person may have some memory problems and trouble finding words, but they can solve everyday problems and competently handle their life affairs.<ref name="hugo">{{cite journal | vauthors = Hugo J, Ganguli M | title = Dementia and cognitive impairment: epidemiology, diagnosis, and treatment | journal = Clinics in Geriatric Medicine | volume = 30 | issue = 3 | pages = 421–442 | date = August 2014 | pmid = 25037289 | pmc = 4104432 | doi = 10.1016/j.cger.2014.04.001 }}</ref> During this stage, it is ideal to ensure that [[advance care planning]] has occurred to protect the person's wishes. [[Advance healthcare directive|Advance directives]] exist that are specific to people living with dementia.<ref>{{Cite web |title=Advance Directive for Dementia |url=https://dementia-directive.org/ |access-date=January 12, 2023 |website=dementia-directive.org |language=en-US}}</ref> These can be particularly helpful in addressing the decisions related to feeding which come with the progression of the illness. Mild cognitive impairment has been relisted in both [[DSM-5]] and [[ICD-11]] as "mild neurocognitive disorders", i.e. milder forms of the major neurocognitive disorder (dementia) subtypes.<ref name="DSM5">{{cite book | author = American Psychiatric Association |url=https://archive.org/details/diagnosticstatis0005unse/page/591|title=Diagnostic and statistical manual of mental disorders : DSM-5|date=2013|publisher=American Psychiatric Association|isbn=978-0-89042-554-1|edition=5th|location=Washington, DC|pages=[https://archive.org/details/diagnosticstatis0005unse/page/591 591–603]}}</ref>

[[Kynurenine]] is a metabolite of [[tryptophan]] that regulates microbiome signaling, immune cell response, and neuronal excitation. A disruption in the [[kynurenine pathway]] may be associated with the neuropsychiatric symptoms and cognitive prognosis in mild dementia.<ref name=Cervenka>{{cite journal |vauthors=Cervenka I, Agudelo LZ, Ruas JL |title=Kynurenines: Tryptophan's metabolites in exercise, inflammation, and mental health |journal=Science |volume=357 |issue=6349 |at=eaaf9794 |date=July 2017 |pmid=28751584 |doi=10.1126/science.aaf9794 |doi-access=free}}</ref><ref name=Solvang>{{cite journal |vauthors=Solvang SH, Nordrehaug JE, Aarsland D, et al |title=Kynurenines, Neuropsychiatric Symptoms, and Cognitive Prognosis in Patients with Mild Dementia |journal=Int J Tryptophan Res |volume=12 |issue= |page=1178646919877883 |date=2019 |pmid=31632053 |pmc=6769202 |doi=10.1177/1178646919877883}}</ref>