Updated guidelines recommend exercise, cognitive training for MCI

Clinicians should recommend exercise and cognitive training for patients with mild cognitive impairment, according to new practice guidelines published in Neurology. The guidelines also point out that little evidence supports use of cholinesterase inhibitors in these patients.

An expert panel updated the 2001 American Academy of Neurology (AAN) guidelines to reflect the most recent research in the assessment and treatment of mild cognitive impairment (MCI).

“The panel addressed four basic questions,” Dan Marson, PhD, JD, co-author of the guidelines and professor emeritus in the department of neurology at the University of Alabama at Birmingham School of Medicine, said in a press release. “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? And what nonpharmacologic treatments are effective for patients diagnosed with MCI?”

The panel recommended that clinicians assess for MCI with validated tools, according to a summary of the AAN guidelines. Patients who test positive for MCI should have more in-depth cognitive testing, like neuropsychological testing, for a more accurate diagnosis because many assessment tools are calibrated to maximize sensitivity instead of specificity. Clinicians must also be able to distinguish between MCI and dementia diagnoses; the panel recommends they find evidence of functional impairment limiting independence in the daily activities of their patients, according to the AAN summary.

The panel advises that when evaluating patients with MCI, clinicians should:

recommend regular exercise based on 6-month studies that suggest they may benefit from twice-weekly exercise for cognition in MCI;

recommend cognitive training because nonmedical cognitive interventions may help improve aspects of cognitive function;

consider not offering cholinesterase inhibitors due to lack of evidence;

check for modifiable risk factors, functional impairment and behavioral/neuropsychiatric symptoms;

monitor cognitive status over time because patients can improve, remain stable or progress cognitively, which may change their diagnosis and management approach;

discontinue cognitively impairing medication where possible; and

discuss diagnosis, prognosis, long-term planning and biomarker research with patients and families.

“Care for persons with MCI continues to evolve, with early identification, diagnosis and education important to patients with MCI and their families,” Marson said in the release. “Where clinicians are not proficient in caring for the cognitive and behavioral or psychiatric needs of persons with MCI, referral to appropriate specialists is an important part of the treatment paradigm in line with the guideline recommendations.” – by Savannah Demko

References:

AAN. AAN Summary of Practice Guideline for Clinicians – Practice Guideline Update: Mild Cognitive Impairment. https://www.aan.com/Guidelines/Home/GetGuidelineContent/882. Accessed on Jan. 3, 2018.

Disclosures: Healio Psychiatry was unable to confirm any relevant financial disclosures at the time of publication.