After I posted and reviewed the links in this post, I found that this guideline is very unhelpful [I left the post in the blog just to remind myself not to waste any more time on it]. There is nothing in the guideline that is not in the abstract which I have included below:
To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive
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.
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.
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).
The article has no guidance on what screening test(s) to use for screening for MCI in the Medicare Annual Wellness Visit.
The article has no guidance on what tests to order to look for reversible causes.
In this post I link to PRACTICE GUIDELINE UPDATE SUMMARY: MILD COGNITIVE IMPAIRMENT*, January 2018, from the American Academy of Neurology. The American Academy Of Neurology has at the time of this post 244 Guidelines. [Link is to the complete list].
*This page links to:
- Clinician Summary [4 page PDF]
- Presentation Slides [46 Slides]
- Podcast [25 minutes]
- Full Length Version
Here is the link to the complete article:
Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Neurology. 2018 Jan 16;90(3):126-135.
The above article has been cited by 72 articles in PubMed Central.
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