Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, Copenhagen, Denmark.
Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden.
Eur J Neurol. 2021 Jul;28(7):2147-2155. doi: 10.1111/ene.14668. Epub 2020 Dec 23.
Careful counseling through the diagnostic process and adequate postdiagnostic support in patients with mild cognitive impairment (MCI) is important. Previous studies have indicated heterogeneity in practice and the need for guidance for clinicians.
A joint European Academy of Neurology/European Alzheimer's Disease Consortium panel of dementia specialists was appointed. Through online meetings and emails, positions were developed regarding disclosing a syndrome diagnosis of MCI, pre- and postbiomarker sampling counseling, and postdiagnostic support.
Prior to diagnostic evaluation, motives and wishes of the patient should be sought. Diagnostic disclosure should be carried out by a dementia specialist taking the ethical principles of "the right to know" versus "the wish not to know" into account. Disclosure should be accompanied by written information and a follow-up plan. It should be made clear that MCI is not dementia. Prebiomarker counseling should always be carried out if biomarker sampling is considered and postbiomarker counseling if sampling is carried out. A dementia specialist knowledgeable about biomarkers should inform about pros and cons, including alternatives, to enable an autonomous and informed decision. Postbiomarker counseling will depend in part on the results of biomarkers. Follow-up should be considered for all patients with MCI and include brain-healthy advice and possibly treatment for specific underlying causes. Advice on advance directives may be relevant.
Guidance to clinicians on various aspects of the diagnostic process in patients with MCI is presented here as position statements. Further studies are needed to enable more evidence-based and standardized recommendations in the future.
在轻度认知障碍（MCI）患者中，通过诊断过程中的仔细咨询和充分的诊断后支持非常重要。先前的研究表明，临床实践存在异质性，需要为临床医生提供指导。
任命了一个由欧洲神经病学会/欧洲阿尔茨海默病联合会痴呆症专家组成的联合小组。通过在线会议和电子邮件，就披露 MCI 综合征诊断、生物标志物采样前和后咨询以及诊断后支持制定了立场。
在进行诊断评估之前，应寻求患者的动机和意愿。诊断披露应由考虑到“知情权”与“不愿知情”伦理原则的痴呆症专家进行。披露应附有书面信息和后续计划。应明确表示 MCI 不是痴呆症。如果考虑进行生物标志物采样，则应进行预生物标志物咨询，如果进行采样，则应进行后生物标志物咨询。应告知具有生物标志物知识的痴呆症专家利弊，包括替代方案，以实现自主和知情决策。后生物标志物咨询将部分取决于生物标志物的结果。应考虑对所有 MCI 患者进行随访，包括大脑健康建议和可能针对特定潜在原因的治疗。预先指示的建议可能相关。
本文提出了针对 MCI 患者诊断过程各个方面的临床医生指导意见。需要进一步研究，以便未来能够提出更具循证依据和标准化的建议。
