American Academy of Neurology Guideline Update: Mild Cognitive Impairment

2017 Dec 27. pii: 10.1212/WNL.0000000000004826. doi: 10.1212/WNL.0000000000004826. [Epub ahead of print]

Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.

Petersen RC1, Lopez O1, Armstrong MJ1, Getchius TSD1, Ganguli M1, Gloss D1, Gronseth GS1, Marson D1, Pringsheim T1, Day GS1, Sager M1, Stevens J1, Rae-Grant A1.

Abstract

Objective

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).

Citation

http://n.neurology.org/content/early/2017/12/27/WNL.0000000000004826

Copyright © 2017 American Academy of Neurology.