McLeod Graham A, Switzer Aaron R, Bartolini Luca, Zea Vera Alonso Gonzalo, Smith Eric E, Ganesh Aravind
Department of Clinical Neurosciences, University of Calgary, Canada.
Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy.
Neurol Clin Pract. 2025 Aug;15(4):e200507. doi: 10.1212/CPJ.0000000000200507. Epub 2025 Jun 25.
The aim of this study was to explore practice patterns in managing mild cognitive impairment (MCI). The investigation and management of MCI is considered important because it offers the opportunity to potentially stave off conversion to dementia. However, there are few data on current practices/approaches in this area, especially worldwide; such data can help identify potential disparities and anticipate adoption of new therapies.
We performed a worldwide electronic survey of neurology practitioners through the Practice Current section of ® with clinical and practice-related questions in November 2019-August 2021 and repeated it in May-October 2023 after the FDA's approval of aducanumab and lecanemab but before the approval of donanemab. Clinical questions addressed access to and utilization of diagnostic investigations, pharmacologic and nonpharmacologic management of MCI, and (in 2023) attitudes toward novel anti-amyloid agents. Responses were compared using the Fisher exact test and multivariable logistic regression adjusted for region, regional income, year of survey response, years in practice, and number of cognitive patients seen annually.
We received 1,257 responses from 95 countries, including 237 cognitive subspecialists and 464 respondents from low-/middle-income countries. On multivariable analysis, cognitive subspecialists were more likely than other practitioners to investigate MCI with a lumbar puncture (aOR 1.90, 95% CI 1.32-2.73), luorodeoxyglucose-PET (FDG-PET) (aOR 1.45, 95% CI 1.00-2.10) and to offer pharmacotherapy if investigations suggested neurodegeneration (aOR 1.92, 95% CI 1.29-2.85). Regionally, respondents from Europe, Latin America, and Asia were more likely than those from the United States/Canada to order FDG-PET (e.g., Europe: aOR 2.38, 95% CI 1.29-4.39) and amyloid PET (Europe: aOR 3.30, 95% CI 1.85-5.87), controlling for reported access to these tests. Pharmacologic and nonpharmacologic approaches were comparable between cognitive subspecialists and other respondents. Despite concerns about safety (77.1% expressed being somewhat or very concerned), attitudes toward prescribing new anti-amyloid agents were similar among all respondents, reflecting a generally favorable attitude (e.g., 62% would prescribe anti-amyloid therapy if it was available).
Our results highlight practice differences among cognitive subspecialists and other practitioners worldwide in the management of MCI. Attitudes toward anti-amyloid therapy indicate cautious optimism, with concerns about side effects but a general interest to prescribe.
本研究旨在探索轻度认知障碍（MCI）的管理实践模式。MCI的调查与管理被认为很重要，因为它提供了潜在延缓向痴呆转化的机会。然而，关于该领域当前实践/方法的数据很少，尤其是在全球范围内；此类数据有助于识别潜在差异并预测新疗法的采用情况。
2019年11月至2021年8月，我们通过®的“实践现状”板块对神经科医生进行了一项全球电子调查，问卷包含临床及与实践相关的问题，并在2023年5月至10月重复进行了调查，此时已获美国食品药品监督管理局（FDA）批准阿杜卡单抗和仑卡奈单抗，但多奈单抗尚未获批。临床问题涉及诊断检查的获取与使用、MCI的药物及非药物管理，以及（2023年）对新型抗淀粉样蛋白药物的态度。使用Fisher精确检验及多变量逻辑回归对回答进行比较，多变量逻辑回归针对地区、区域收入、调查回复年份、从业年限及每年诊治的认知障碍患者数量进行了调整。
我们收到了来自95个国家的1257份回复，其中包括237名认知障碍专科医生以及来自低收入/中等收入国家的464名受访者。在多变量分析中，认知障碍专科医生比其他从业者更有可能通过腰椎穿刺（调整后比值比[aOR] 1.90，95%置信区间[CI] 1.32 - 2.73）、氟脱氧葡萄糖正电子发射断层扫描（FDG - PET）（aOR 1.45，95% CI 1.00 - 2.10）来调查MCI，并且如果检查提示神经退行性变则更有可能提供药物治疗（aOR 1.92，95% CI 1.29 - 2.85）。在地区方面，欧洲、拉丁美洲和亚洲的受访者比美国/加拿大的受访者更有可能开具FDG - PET检查单（例如，欧洲：aOR 2.38，95% CI 1.29 - 4.39）和淀粉样蛋白PET检查单（欧洲：aOR 3.30，95% CI 1.85 - 5.87），已对报告的这些检查的获取情况进行了控制。认知障碍专科医生和其他受访者在药物及非药物方法上相当。尽管对安全性存在担忧（77.1%表示有些或非常担忧），但所有受访者对开具新型抗淀粉样蛋白药物的态度相似，反映出总体上持积极态度（例如，62%表示如果有抗淀粉样蛋白疗法就会开具）。
我们的结果凸显了全球范围内认知障碍专科医生和其他从业者在MCI管理方面的实践差异。对抗淀粉样蛋白疗法的态度表明谨慎乐观，虽对副作用有所担忧，但普遍有开具药物的意愿。
