Marwan N. Sabbagh, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA,
J Prev Alzheimers Dis. 2020;7(3):165-170. doi: 10.14283/jpad.2020.21.
Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to multi-dimensional frictions and barriers associated with evaluating individuals' cognitive performance. To move toward large-scale cognitive screening, a global panel of clinicians and cognitive neuroscientists convened to elaborate on current challenges that hamper widespread cognitive performance assessment. This report summarizes a conceptual framework and provides guidance to clinical researchers and test developers and suppliers to inform ongoing refinement of cognitive evaluation. This perspective builds upon a previous article in this series, which outlined the rationale for and potentially against efforts to promote widespread detection of MCI. This working group acknowledges that cognitive screening by default is not recommended and proposes large-scale evaluation of individuals with a concern or interest in their cognitive performance. Such a strategy can increase the likelihood to timely and effective identification and management of MCI. The rising global incidence of AD demands innovation that will help alleviate the burden to healthcare systems when coupled with the potentially near-term approval of disease-modifying therapies. Additionally, we argue that adequate infrastructure, equipment, and resources urgently should be integrated in the primary care setting to optimize the patient journey and accommodate widespread cognitive evaluation.
轻度认知障碍 (MCI) 在初级保健环境中被严重误诊，这是由于评估个体认知表现时存在多方面的摩擦和障碍。为了实现大规模认知筛查，一组全球临床医生和认知神经科学家齐聚一堂，详细阐述了阻碍广泛认知表现评估的当前挑战。本报告总结了一个概念框架，并为临床研究人员和测试开发人员和供应商提供了指导，以告知认知评估的持续改进。本观点建立在本系列之前的一篇文章的基础上，该文章概述了推广 MCI 广泛检测的理由和潜在障碍。该工作组承认，默认情况下不建议进行认知筛查，并建议对关注或对自己认知表现感兴趣的个体进行大规模评估。这种策略可以增加及时有效地识别和管理 MCI 的可能性。随着 AD 的全球发病率不断上升，需要创新，这将有助于减轻医疗系统的负担，同时潜在地在近期批准疾病修饰疗法。此外，我们认为，应紧急将足够的基础设施、设备和资源纳入初级保健环境，以优化患者的就诊流程并适应广泛的认知评估。
