Mild cognitive impairment clinical syndrome may be applied to some patients presenting with decline in their cognition. Once identified they are offered support and resources to enable them to adjust to the difficulties as a result of cognitive decline, including accessing prevention strategies and access to research.
For extra information, evidence and best practice please scroll down to the bottom of the page.
Mild Cognitive Impairment
Mild Cognitive Impairment (MCI) - A Guide for the Public: https://www.youtube.com/watch?v=mudsX6ODwyw&t=4s
Mild Cognitive Impairment (MCI) - A Guide for the Professionals: https://www.youtube.com/watch?v=_81KxyKhNlw
Information for people diagnosed with MCI in GM: https://dementia-united.org.uk/wp-content/uploads/sites/4/2019/10/Information-for-people-diagnosed-with-MCI-in-GM.pdf
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MCI is not a diagnosis in its own right, rather a clinical syndrome which may be caused by a range of physical and psychological factors. Clinicians should attempt to provide patients with an explanation for their decline in cognition, which in some cases will include using biomarkers for the early detection of neurodegeneration.
Unfortunately, there is currently no NICE guidance on MCI however, NICE Clinical Knowledge Summaries state the following information for primary care practitioners on the management of MCI:
• Discuss the diagnosis without provoking undue anxiety.
• Arrange regular follow-up visits (for example annually) to monitor possible progression of cognitive deficit. If symptoms deteriorate refer for specialist assessment and management.
• Suggest healthy brain activities such as regular exercise, word games, and socialisation.
Growing evidence suggests that addressing lifestyle risk factors in people with a MCI may slow disease progression or even reduce their risk of progressing to dementia.
The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) randomised controlled trial, demonstrated that a combination of interventions related to diet, exercise, cognitive training and vascular risk monitoring could improve or maintain cognitive functioning in elderly people who were at risk for dementia.
Best Practice Resources
In 2019 a consensus meeting of researchers, clinicians and other stakeholders was convened in Manchester, UK, the following recommendations came from these meetings:
- There is currently no NICE guidance on MCI. This means there is no guidance as to how a large proportion of cases seen in UK cognitive and memory clinics should be investigated and managed. This leads to wide variation in clinical practice and hinders optimal management of these patients. NICE guidelines for the investigation and follow-up of the MCI syndrome are urgently required.
- MCI should be considered a clinical syndrome with heterogeneous underlying pathologies and not a diagnosis in its own right. Clinicians should attempt to provide patients with an explanation for their decline in cognition, which in some cases will include using biomarkers for the early detection of neurodegeneration.
- Over-investigation of people with subjective cognitive problems but little objective evidence of cognitive decline may exacerbate health anxieties where present.
- For patients falling within the rubric of MCI, it is important to identify and treat potentially modifiable contributions to their cognitive dysfunction including but not limited to the treatment of physical illness, depression and other psychiatric disorders, isolation, optimisation of hearing and visual disturbance, recommendations and interventions to promote alcohol cessation, and rationalisation of medications (e.g. anticholinergics, hypnotics and opiates).
- Given the heterogeneity of MCI, decisions about whom to investigate and the depth of that investigation, including the utility of molecular biomarkers, should be made on an individual basis. However, as for patients with dementia, blood screening is recommended, and patients with objective cognitive decline are likely to be offered structural imaging.
- Patients with MCI should have equitable access to neuropsychological testing and expertise.
- Procedures for implementing monitoring technologies of cognition and functional deterioration in clinical practice are required.
- NICE guidance for dementia supports the use of CSF biomarkers in the diagnosis of Alzheimer’s disease. Given the complexity of diagnosing patients with MCI and emerging evidence that CSF can aid in prognostication, CSF sampling may be useful on an individual by individual basis in patients with MCI in whom a diagnosis of Alzheimer’s disease is suspected. The NHS requires evidence-based guidance on the use of biomarkers in mild cognitive impairment, and this should form part of any NICE guidance. The advent of disease-modifying therapies for prodromal Alzheimer’s disease would mean that significant investment in biomarker and neuroimaging infrastructure would be necessary to ensure timely access for NHS patients. This will require significant planning and engagement with commissioners and providers.
- Patients with MCI should be offered review at least annually in either primary or secondary care.
- All patients with MCI should be offered access to research.
- Research on MCI should include not only measures of economic and healthcare utilisation, but also examine the psychosocial impact of being diagnosed with MCI on patients and carers. "Those with mild cognitive impairment should be routinely offered the opportunity to participate in clinical trials and other research studies, including those on Join Dementia Research.
The MCI consensus can be found here
Dementia United's website hosts a number of useful resources including video's leaflets and training packages for anyone interested in learning more about MCI and better supporting people living with this condition.