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Mild cognitive impairment: the Manchester consensus

Lookup NU author(s): Dr Dag Aarsland, Professor John O'Brien, Dr Clive Ballard, Professor John Isaacs, Professor Alan Thomas

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society.Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5-15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer's disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI.


Publication metadata

Author(s): Dunne RA, Aarsland D, O'Brien JT, Ballard C, Banerjee S, Fox NC, Isaacs JD, Underwood BR, Perry RJ, Chan D, Dening T, Thomas AJ, Schryer J, Jones A-M, Evans AR, Alessi C, Coulthard EJ, Pickett J, Elton P, Jones RW, Mitchell S, Hooper N, Kalafatis C, Rasmussen JGC, Martin H, Schott JM, Burns A

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2021

Volume: 50

Issue: 1

Pages: 72-80

Print publication date: 01/01/2021

Online publication date: 17/11/2020

Acceptance date: 02/04/2018

Date deposited: 24/03/2021

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press

URL: https://doi.org/10.1093/ageing/afaa228

DOI: 10.1093/ageing/afaa228

PubMed id: 33197937


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