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).
Glossary
- AAN=
- American Academy of Neurology;
- AD=
- Alzheimer disease;
- aMCI=
- amnestic mild cognitive impairment;
- CI=
- confidence interval;
- CIND=
- cognitively impaired, no dementia;
- FDA=
- Food and Drug Administration;
- IADL=
- instrumental activities of daily living;
- MCI=
- mild cognitive impairment;
- RR=
- relative risk
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Approved by the Guideline Development, Dissemination, and Implementation Subcommittee on July 16, 2016; by the Practice Committee on August 22, 2016; and by the AAN Institute Board of Directors on October 5, 2017.
This guideline was endorsed by the Alzheimer's Association on May 1, 2017.
- Received February 24, 2017.
- Accepted in final form September 22, 2017.
- Copyright © 2017 American Academy of Neurology
Disputes & Debates: Rapid online correspondence
- Author response to Braillon: Practice guideline update summary: Mild cognitive impairment: Report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology
- RE: Author response to Valenzuela et al.
- Practice guideline update summary: Mild cognitive impairment: Report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology
- Author response to Drs. Wang and Cui
- Concerns about cholinesterase inhibitor recommendations
- Reader response: Practice guideline update summary: MCI
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