Mild cognitive impairment (MCI) is a condition in which individuals demonstrate cognitive impairment with minimal impairment of instrumental activities of daily living (IADL).1–3 Although MCI can be the first cognitive expression of Alzheimer disease (AD), it can also be secondary to other disease processes (i.e., other neurologic, neurodegenerative, systemic, or psychiatric disorders).4 The term amnestic MCI (aMCI) describes a syndrome in which memory dysfunction predominates; in nonamnestic MCI, impairment of other cognitive features (e.g., language, visuospatial, executive) is more prominent.2
This practice guideline updates a 2001 American Academy of Neurology (AAN) practice parameter with recommendations concerning the diagnosis and treatment of MCI.5 The guideline focuses on presumed idiopathic or neurodegenerative MCI—particularly relating to AD—rather than mild cognitive changes relating to potentially reversible causes (e.g., metabolic, vascular, systemic, or psychiatric disorders) or Parkinson disease–MCI or vascular cognitive impairment, as these may have different epidemiologic and treatment spectra than AD. This article summarizes the guideline findings, conclusions, and recommendations. The full text of the guideline, including appendices e-1 through e-8, is available as supplemental data (links.lww. com/WNL/A125), as are tables e-1 through e-3 (links.lww.com/ WNL/A34) and references e1–e50 (links.lww.com/WNL/A50).
The guideline addresses 4 questions:
What is the prevalence of MCI in the general population?
What is the prognosis for patients diagnosed with MCI for progression to a diagnosis of dementia, and how does this compare with an age-matched general population?
What pharmacologic treatments are effective for patients diagnosed with MCI?
What nonpharmacologic treatments are effective for patients diagnosed with MCI?
This guideline does not review the rapidly evolving field of biomarker research in MCI; the guideline panel determined that this should be the subject of a future guideline or systematic review. In addition, the potential psychological distress of a diagnosis of MCI (which has been discussed in the literature) was not one of the questions reviewed by the expert panel for this guideline.6