Mild Cognitive Impairment (MCI) as a Useful Clinical Diagnosis – Practice Guidelines Are Needed
Posted Jul 15 2009 6:56pm
"Our results show that neurologists regularly see and treat people with MCI, despite the fact that the medications they are prescribing are not FDA-approved for this particular diagnostic category," Scott Roberts said. "Clinicians vary greatly in the education and support they provide or recommend for people with MCI, suggesting that there is a need for practice guidelines in this area. Millions of people can be classified as having MCI, and these numbers are expected to rise in coming years. It is important to establish professional consensus about appropriate care for this population."
Neurologists Views MCI as a Useful Clinical Diagnosis – Practice Guidelines Are Needed
Mild cognitive impairment (MCI) is a category of cognitive status that is used in research to define the state between normal aging and Alzheimer's, and it is now entering clinical practice. Little is known about how it is being used by clinicians or how they view the benefits and limitations of MCI as a clinical category.
In MCI, a person has problems with memory, language, or another mental function severe enough to be noticeable to other people and to show up on tests, but not serious enough to interfere with their daily life. Because the problems do not interfere with daily activities, the person is not diagnosed with Alzheimer's or another dementia. The best-studied type of MCI involves a memory problem and is called "amnestic MCI."
Research has shown that people with MCI have an increased risk of developing Alzheimer's over the next few years, especially when their main problem is memory. However, not everyone diagnosed with MCI goes on to develop Alzheimer's. There is currently no treatment for MCI approved by the FDA. Numerous clinical trials are investigating treatments to delay or prevent Alzheimer's in MCI populations.
Scott Roberts, PhD, Assistant Professor of Health Behavior & Health Education at the University of Michigan's School of Public Health; Jason Karlawish, MD, Associate Professor of Medicine and Medical Ethics with tenure, Senior Fellow of the Center for Bioethics and the Leonard Davis Institute of Health Economics, and Associate Scholar at the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania; and colleagues sought to assess how neurologists are diagnosing and treating patients with mild cognitive symptoms and how they view MCI as a clinical diagnosis. They surveyed members of the American Academy of Neurology (AAN) who had indicated a clinical practice focus on aging/dementia or behavioral neurology in a recent AAN Member Census using mail, fax and the Internet.
420 clinicians (response rate=48%) completed the survey. 88% reported at least monthly encounters with patients experiencing mild cognitive symptoms. Most respondents recognize MCI as a clinical diagnosis (90%) and use its diagnostic code for billing purposes (70%). When seeing this population, most respondents report routinely making recommendations for monitoring and follow-up (88%), counseling patients on physical (78%) and mental exercise (75%), and communicating about risk of dementia (63%).
Most respondents (70%) prescribe cholinesterase inhibitors at least sometimes for this population, with memantine (39%) and "other" agents (e.g., vitamin E, gingko) prescribed less frequently. Cholinesterase inhibitors and memantine are FDA-approved drugs for Alzheimer's. Relatively few respondents routinely provide information on support services (27%) or a written summary of findings (15%).
Respondents endorsed several benefits of making a clinical diagnosis of MCI:
Labeling the problem is helpful (91%)
Involving the patient in planning for the future (87%)
Motivating the patient's risk reduction activities (85%)
Helping the family with financial planning (72%)
Prescribing medications useful for treating MCI (65%)
Some respondents noted potential drawbacks of MCI as a clinical diagnosis, including:
It is too difficult to diagnose accurately or reliably (23%)
It is usually better described as early AD (21%)
A diagnosis can cause unnecessary worry (20%)
"Our results show that neurologists regularly see and treat people with MCI, despite the fact that the medications they are prescribing are not FDA-approved for this particular diagnostic category," Roberts said. "Clinicians vary greatly in the education and support they provide or recommend for people with MCI, suggesting that there is a need for practice guidelines in this area. Millions of people can be classified as having MCI, and these numbers are expected to rise in coming years. It is important to establish professional consensus about appropriate care for this population."
According to Roberts, the AAN is currently engaged in an evidence-based medicine review of the literature to develop a new practice parameter for MCI.
Scott Roberts, et al -- Clinical Practices Regarding Mild Cognitive Impairment (MCI) Among Neurology Service Providers (Funder: Alzheimer's Association)
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Bob DeMarco is an Alzheimer's caregiver and editor of the Alzheimer's Reading Room. The Alzheimer's Reading Room is the number one website on the Internet for advice and insight into Alzheimer's disease. Bob taught at the University of Georgia, was an executive at Bear Stearns, the CEO of IP Group, and is a mentor. He has written more than 700 articles with more than 18,000 links on the Internet. Bob resides in Delray Beach, FL.