Expert clinicians call for new consensus on Mild Cognitive Impairment


By Alex Smith | Tuesday 17 November 2020

Top clinicians and dementia experts from the NHS, universities, pharmaceutical organisations and charities have today (Tuesday 17 November) published their consensus on Mild Cognitive Impairment (MCI).

The University of Manchester and Greater Manchester Health and Social Care Partnership, through its Dementia United programme, spearheaded the review, which calls for a fresh focus on how MCI should be recognised, diagnosed, and treated. The review is published in the medical journal Age and Ageing.

MCI is an umbrella term given to a noticeable and measurable change in a person’s memory or thinking, which does not interfere with activities of their daily life. Currently the syndrome is diagnosed based on symptoms alone. While around ten to 15 percent of those living with MCI go on to develop dementia per year, a significant proportion will remain stable or improve, making this confusing and challenging for patients and doctors alike.

This new review lays out three key areas to consider as we think and deal with MCI.

  • MCI should be recognised as a clinical syndrome caused by different underlying diseases.
  • Clinicians should try their best to provide patients with an explanation for their symptoms. This will vary from patient to patient, but in many cases it may be appropriate to use scans, lumbar punctures and other tests to try and make as accurate and early diagnosis as possible.
  • There should be national guidance on dealing with MCI to provide consistency to clinicians and the patients they treat.

Any future treatments are likely to need to be given early in the disease process, making a strategy for dealing with MCI even more important.

The authors also recommend that those with MCI should be routinely offered the opportunity to participate in clinical trials and other research studies, citing the national ‘Join Dementia Research’ service, which is partnered with Alzheimer’s Research UK and Alzheimer’s Society.

Dr Ross Dunne, Consultant psychiatrist from Greater Manchester Mental Health NHS Foundation Trust, said:
“Currently we don’t use biological markers from blood or spinal fluids to help give a diagnosis of Mild Cognitive Impairment (MCI). We recommend that this should be brought in early in the process to help resolve cases and shed light on the underlying diseases at play.

“What we really need to see is national guidance to ensure that people with MCI receive the same treatment wherever they are in the country, and this should involve a strategy for allowing people to get involved in research. A national plan would help support people across the UK who are experiencing these symptoms, create consistency in how we diagnose MCI and accelerate research into better treatments.”

Dr Dunne is also part of the Mental Health Domain within Manchester Academic Health Science Centre (MAHSC) and Health Innovation Manchester. The domain conducts translational research in mental health and dementia care for the benefit of the local Greater Manchester population.

Warren Heppolette, executive lead for strategy and system development at the Greater Manchester Health and Social Care Partnership said:

“The Consensus, with its key focus on how mild cognitive impairment can be recognised and understood, is a real step forward.  Across Greater Manchester, we want to help people with lived experience and carers to better access prevention activities and opportunities to obtain the correct diagnosis and support, and we continue to support this important work.”

Prof Jonathan Schott, Chief Medical Officer at Alzheimer’s Research UK, and an author of the report said:

“We know that there is huge variability in how frequently MCI is diagnosed across the country and whether or not people with MCI undergo further investigations to try and identify its cause.

“Like dementia, MCI is an umbrella term describing several symptoms, and can be caused by a number of different underlying diseases. We know that over 50% of people with MCI will go on to develop dementia, and it is important that we try and identify those who will and those who will not progress to be able to offer appropriate treatment and advice. This will become even more pressing as and when new treatments for specific forms of dementia become available. We urgently need to prepare the healthcare system for any future changes in the treatment landscape, and this must include our approach to dealing with MCI.”

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Alex Smith