• Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001 May 8;56(9):1133-42. [47 references]

This is the current release of the guideline.

According to the guideline developer, this guideline has been reviewed and is still considered to be current as of October 2003. This review involved new literature searches of electronic databases followed by expert committee review of new evidence that has emerged since the original publication date.

Classification of evidence ratings, I-III, and the levels of recommendations (Standard, Guideline, Option) are defined at the end of the "Major Recommendations" field.

1. Does the presence of mild cognitive impairment predict the development of dementia?

   Conclusion: Studies indicate that individuals characterized as being cognitively impaired but not meeting clinical criteria for dementia or Alzheimer's disease (mild cognitive impairment) have a high risk of progressing to dementia or Alzheimer's disease. If the figures for incident Alzheimer's disease from the general population are used (Table 4 in the original guideline document), one can see that the rates range from 0.2% in the 65 to 69 year age rage to 3.9% in the 85 to 89 year range. The studies of mild cognitive impairment indicate that the rate of progression to dementia of Alzheimer's disease is between 6 and 25% per year.

   Practice Recommendation: Patients with mild cognitive impairment should be recognized and monitored for cognitive and functional decline due to their increased risk for subsequent dementia (Guideline).

2. Does screening at-risk subjects with a specific instrument in a specific setting accurately lead to the diagnosis of dementia?

   General Cognitive Screening Instruments

   Conclusion: General cognitive screening instruments, which include the Mini-Mental State Examination, Kokmen Short Test of Mental Status, 7-Minute Screen, and Memory Impairment Screen, are useful for the detection of dementia when used in patient populations with an elevated prevalence of cognitive impairment either due to age or presence of memory dysfunction.

   Practice Recommendation: General cognitive screening instruments (e.g., Mini-Mental State Examination) should be considered for the detection of dementia in individuals with suspected cognitive impairment (Guideline).

   Brief Focused Screening Instruments

   Conclusion: Recently, attempts have been made to develop useful screening tools that can be administered in a brief time frame. Caution must be exercised because of the limited scope of these tools.

   Practice Recommendation: Brief cognitive assessment instruments that focus on limited aspects of cognitive function (i.e., Clock Drawing Test, Time and Change Test) may be considered when screening patients for dementia (Option).

   Neuropsychologic Batteries

   Conclusion: Neuropsychologic batteries are useful instruments in identifying patients with dementia, particularly when administered to an increased-risk (by virtue of memory impairment) population. Those neuropsychologic instruments that emphasize memory function are most useful.

   Practice Recommendation: Neuropsychologic batteries should be considered useful in identifying patients with dementia, particularly when administered to a population at increased risk of cognitive impairment (Guideline).

   Informant-based Batteries

   Conclusion: Interview-based techniques (i.e., Blessed Dementia Rating Scale, Clinical Dementia Rating, Informant Questionnaire on Cognitive Decline in the Elderly) may be useful in identifying patients with dementia, particularly when administered to patients who are at increased risk of developing dementia by virtue of age or memory impairment. These instruments emphasize the importance of obtaining information concerning the cognitive and functional status of persons from an informed source.

   Practice Recommendation: Interview-based techniques may be considered in identifying patients with dementia, particularly in a population at increased risk for cognitive impairment (Option).

Definitions:

Classification of Evidence

Class I. Evidence provided by one or more well-designed, randomized, controlled clinical trials, including overviews (meta-analyses) of such trials.

Class II. Evidence provided by well-designed, observational studies with concurrent controls (e.g., case control or cohort studies).

Class III. Evidence provided by expert opinion, case series, case reports, and studies with historical controls.

Levels of Recommendation

Standard. Principle for patient management that reflects a high degree of clinical certainty. (Usually requires Class I evidence that directly addresses clinical questions, or overwhelming Class II evidence when circumstances preclude randomized clinical trials.)

Guideline. Recommendation for patient management that reflects moderate clinical certainty. (Usually requires Class II evidence or a strong consensus of Class III evidence.)

Option. Strategy for patient management for which clinical utility is uncertain (inconclusive or conflicting evidence or opinion).

None provided

The recommendations are based on a review of the literature. The type of supporting evidence is identified and graded for each recommendation on the early detection of dementia (see "Major Recommendations" field).

• Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001 May 8;56(9):1133-42. [47 references]

Not applicable: Guideline was not adapted from another source.

2001 May (reviewed 2003)

American Academy of Neurology - Medical Specialty Society

American Academy of Neurology (AAN)

Quality Standards Subcommittee

Authors: R.C. Petersen, PhD, MD; J.C. Stevens, MD; M. Ganguli, MD, MPH; E.G. Tangalos, MD; J.L. Cummings, MD; and S.T. DeKosky, MD

All panel members provided comprehensive disclosures of any real or potential conflicts of interest.

American Association of Neuroscience Nurses - Professional Association
American Geriatrics Society - Medical Specialty Society

This is the current release of the guideline.

According to the guideline developer, this guideline has been reviewed and is still considered to be current as of October 2003. This review involved new literature searches of electronic databases followed by expert committee review of new evidence that has emerged since the original publication date.

This NGC summary was completed by ECRI on February 12, 2002. The information was verified by the guideline developer on September 22, 2003.

This NGC summary is based on the original guideline, which is copyrighted by the American Academy of Neurology.