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Abstract
Objective: To assess how neurologists view mild cognitive impairment (MCI) as a clinical diagnosis and how they treat patients with mild cognitive symptoms.
Methods: Members of the American Academy of Neurology with an aging, dementia, or behavioral neurology practice focus were surveyed by self-administered questionnaire.
Results: Survey respondents were 420 providers (response rate 48%), and 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 these patients, most respondents routinely provide counseling on physical (78%) and mental exercise (75%) and communicate about dementia risk (63%); fewer provide information on support services (27%) or a written summary of findings (15%). Most (70%) prescribe cholinesterase inhibitors at least sometimes for this population, with memantine (39%) and other agents (e.g., vitamin E) prescribed less frequently. Respondents endorsed several benefits of a diagnosis of MCI: 1) involving the patient in planning for the future (87%); 2) motivating risk reduction activities (85%); 3) helping with financial planning (72%); and 4) prescribing medications (65%). Some respondents noted drawbacks, including 1) too difficult to diagnose (23%); 2) better described as early Alzheimer disease (21%); and 3) diagnosis can cause unnecessary worry (20%).
Conclusions: Patients with mild cognitive symptoms are commonly seen by neurologists, who view MCI as a useful diagnostic category. Information and treatments provided to patients with MCI vary significantly, suggesting a need for practice guidelines and further research on clinical decision-making with this population.
Footnotes
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Supplemental data at www.neurology.org
Study funding: Supported by a grant to Dr. Roberts from the Alzheimer's Association. The Geriatric and Behavioral Neurology sections of the American Academy of Neurology (AAN) endorsed the survey; the AAN Surveys and Research Department conducted the survey and provided financial compensation to members for participation. Dr. Green is supported by NIH grants R01-HG02213, K24-AG027841, and P30-AG13846. W.R. Uhlmann is supported by NIH grant HG02213. Dr. Karlawish is supported by NIH grant P30-AG-10124, the Robert Wood Johnson Foundation Investigator Award in Health Policy Research, and the Marian S. Ware Alzheimer Program. Dr. Petersen is supported by NIH grants P50 AG016574, U01 AG006786, and U01 AG024904.
Disclosure: Author disclosures are provided at the end of the article.
Received December 13, 2009. Accepted in final form April 12, 2010.
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