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Guideline Update for Mild Cognitive Impairment
TAKE-HOME MESSAGE
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The practice guideline panel reviewed articles on the prevalence, prognosis, and treatment of mild cognitive impairment in older adults. They uncovered no high-quality evidence that pharmacologic therapies are beneficial in mild cognitive impairment. Exercise and cognitive training, however, may improve cognition.
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The updated guideline recommends that clinicians suggest exercise and possibly cognitive training for patients with mild cognitive impairment. If the question of prescribing cholinesterase inhibitors comes up, they should first discuss with their patients the lack of evidence of any associated benefits.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI).
METHODS
The guideline panel systematically reviewed MCI prevalence, prognosis, and treatment articles according to AAN evidence classification criteria, and based recommendations on evidence and modified Delphi consensus.
RESULTS
MCI prevalence was 6.7% for ages 60-64, 8.4% for 65-69, 10.1% for 70-74, 14.8% for 75-79, and 25.2% for 80-84. Cumulative dementia incidence was 14.9% in individuals with MCI older than age 65 years followed for 2 years. No high-quality evidence exists to support pharmacologic treatments for MCI. In patients with MCI, exercise training (6 months) is likely to improve cognitive measures and cognitive training may improve cognitive measures.
MAJOR RECOMMENDATIONS
Clinicians should assess for MCI with validated tools in appropriate scenarios (Level B). Clinicians should evaluate patients with MCI for modifiable risk factors, assess for functional impairment, and assess for and treat behavioral/neuropsychiatric symptoms (Level B). Clinicians should monitor cognitive status of patients with MCI over time (Level B). Cognitively impairing medications should be discontinued where possible and behavioral symptoms treated (Level B). Clinicians may choose not to offer cholinesterase inhibitors (Level B); if offering, they must first discuss lack of evidence (Level A). Clinicians should recommend regular exercise (Level B). Clinicians may recommend cognitive training (Level C). Clinicians should discuss diagnosis, prognosis, long-term planning, and the lack of effective medicine options (Level B), and may discuss biomarker research with patients with MCI and families (Level C).
Additional Info
Practice Guideline Update Summary: Mild Cognitive Impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology
Neurology 2018 Jan 16;90(3)126-135, RC Petersen, O Lopez, MJ Armstrong, TSD Getchius, M Ganguli, D Gloss, GS Gronseth, D Marson, T Pringsheim, GS Day, M Sager, J Stevens, A Rae-GrantFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This practice guideline updates the 2001 American Academy of Neurology guideline on mild cognitive impairment (MCI). MCI consists of minimal impairment of instrumental activities of daily living (IADL). Prevalence increases by age from 6.7% for 60- to 64-year-olds to 25.2% for age 80 to 84, and dementia developed in 14.9% in those with MCI >65 years followed for 2 years.
Major recommendations by level of evidence:
These guidelines give us hope that exercise and managing risk factors, including inappropriate medications, can make a difference in preventing MCI and dementia. Medicare pays us to screen for cognitive decline as part of the annual wellness visit. And screening can give us providers the opportunity to talk about advanced directives and placement options if family support is insufficient, and can give patients and families reassurance if screening is negative.
References