From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH.
Neurology. 2018 Jan 16;90(3):126-135. doi: 10.1212/WNL.0000000000004826. Epub 2017 Dec 27.
OBJECTIVE: To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI). METHODS: 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. RESULTS: 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. MAJOR RECOMMENDATIONS: 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).
目的：更新 2001 年美国神经病学学会（AAN）关于轻度认知障碍（MCI）的指南。
方法：指南小组根据 AAN 证据分类标准系统地回顾了 MCI 的患病率、预后和治疗文献，并根据证据和修改后的德尔菲共识提出了建议。
结果：60-64 岁年龄组的 MCI 患病率为 6.7%，65-69 岁年龄组为 8.4%，70-74 岁年龄组为 10.1%，75-79 岁年龄组为 14.8%，80-84 岁年龄组为 25.2%。随访 2 年，65 岁以上 MCI 患者累积痴呆发生率为 14.9%。没有高质量的证据支持 MCI 的药物治疗。在 MCI 患者中，运动训练（6 个月）可能改善认知指标，认知训练可能改善认知指标。
主要建议：临床医生应在适当的情况下使用经过验证的工具评估 MCI（B 级）。临床医生应评估 MCI 患者的可改变危险因素，评估功能障碍，评估和治疗行为/神经精神症状（B 级）。临床医生应随时间监测 MCI 患者的认知状态（B 级）。尽可能停用致认知障碍的药物，并治疗行为症状（B 级）。临床医生可以选择不提供胆碱酯酶抑制剂（B 级）；如果提供，他们必须首先讨论缺乏证据（A 级）。临床医生应建议定期锻炼（B 级）。临床医生可以建议认知训练（C 级）。临床医生应与 MCI 患者及其家属讨论诊断、预后、长期规划以及缺乏有效药物选择（B 级），并可能与 MCI 患者及其家属讨论生物标志物研究（C 级）。
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