Reconsidering the overdiagnosis of mild cognitive impairment for dementia prevention among adults aged ≥80 years
Yohko Maki 11National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan. Email: makiyk@ncgg.go.jp
Journal of Primary Health Care 13(2) 112-115 https://doi.org/10.1071/HC20115
Published: 17 June 2021
Journal Compilation © Royal New Zealand College of General Practitioners 2021 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
A diagnosis at the stage of mild cognitive impairment (MCI) is encouraged to promote dementia prevention since intensive intervention during the mild stage is thought to be effective for dementia prevention. Many adults aged ≥80 years hope to prevent dementia; however, several issues should be considered regarding the diagnosis of MCI. First, the diagnosis of MCI is not clear-cut in actual medical practice, with the differentiation of MCI from normal states and mild dementia being blurred. Second, although MCI due to Alzheimer’s disease can be differentiated from MCI without pathological changes, interventions specific to MCI due to Alzheimer’s disease have not been developed. Third, the diagnosis of MCI can cause self-stigma, leading to psychological effects such as depression and anxiety for both the patients and their families, which can be risk factors for developing dementia for patients. In addition, medical resources are limited and diagnosing MCI is costly in medical human resources. Considering these issues, diagnosing MCI to promote dementia prevention should be viewed from the perspective of the individual patient’s interests, especially for those aged ≥80 years. The final decision regarding receiving a diagnosis or not should be the patient’s; therefore, it is necessary to increase patients’ health literacy, which requires medical professionals to provide them with appropriate evidence-based information. At the same time, it is important to provide psychological support to people who have been diagnosed.
KEYwords: Mild cognitive impairment; quality of life; right to be diagnosed; right to not be diagnosed; dementia; dementia prevention; overdiagnosis; health literacy; publication bias; social security cost.
References
[1] Eshkoor SA, Hamid TA, Mun CY, Ng CK. Mild cognitive impairment and its management in older people. Clin Interv Aging 2015; 10 687–93.| Mild cognitive impairment and its management in older people.Crossref | GoogleScholarGoogle Scholar | 25914527PubMed |
[2] Ströhle A, Schmidt DK, Schultz F, et al. Drug and exercise treatment of Alzheimer disease and mild cognitive impairment: a systematic review and meta-analysis of effects on cognition in randomized controlled trials. Am J Geriatr Psychiatry 2015; 23 1234–49.
| Drug and exercise treatment of Alzheimer disease and mild cognitive impairment: a systematic review and meta-analysis of effects on cognition in randomized controlled trials.Crossref | GoogleScholarGoogle Scholar | 26601726PubMed |
[3] Fink HA, Jutkowitz E, McCarten JR, et al. Pharmacologic interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia: a systematic review. Ann Intern Med 2018; 168 39–51.
| Pharmacologic interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia: a systematic review.Crossref | GoogleScholarGoogle Scholar | 29255847PubMed |
[4] Cooper C, Li R, Lyketsos C, Livingston G. Treatment for mild cognitive impairment: systematic review. Br J Psychiatry 2013; 203 255–64.
| Treatment for mild cognitive impairment: systematic review.Crossref | GoogleScholarGoogle Scholar | 24085737PubMed |
[5] Butler M, McCreedy E, Nelson VA, et al. Does cognitive training prevent cognitive decline? A systematic review. Ann Intern Med 2018; 168 63–8.
| Does cognitive training prevent cognitive decline? A systematic review.Crossref | GoogleScholarGoogle Scholar | 29255842PubMed |
[6] Mohajeri MH, Leuba G. Prevention of age-associated dementia. Brain Res Bull 2009; 80 315–25.
| Prevention of age-associated dementia.Crossref | GoogleScholarGoogle Scholar | 19576269PubMed |
[7] Winblad B, Amouyel P, Andrieu S, et al. Defeating Alzheimer’s disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15 455–532.
| Defeating Alzheimer’s disease and other dementias: a priority for European science and society.Crossref | GoogleScholarGoogle Scholar | 26987701PubMed |
[8] Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999; 56 303–8.
| Mild cognitive impairment: clinical characterization and outcome.Crossref | GoogleScholarGoogle Scholar | 10190820PubMed |
[9] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, Virginia: American Psychiatric Association; 2013.
[10] Valenzuela M, Sachdev P. Can cognitive exercise prevent the onset of dementia? Systematic review of randomized clinical trials with longitudinal follow-up. Am J Geriatr Psychiatry 2009; 17 179–87.
| Can cognitive exercise prevent the onset of dementia? Systematic review of randomized clinical trials with longitudinal follow-up.Crossref | GoogleScholarGoogle Scholar | 19225276PubMed |
[11] McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association Workgroups on Diagnostic Guidelines for Alzheimer’s Disease. Alzheimers Dement 2011; 7 263–9.
| The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association Workgroups on Diagnostic Guidelines for Alzheimer’s Disease.Crossref | GoogleScholarGoogle Scholar | 21514250PubMed |
[12] World Health Organization. The Ottawa Charter for Health Promotion. Geneva, Switzerland: WHO; 1986. [cited 2020 October 7]. Available from: https://www.who.int/healthpromotion/conferences/previous/ottawa/en/
[13] Rasmussen J, Langerman H. Alzheimer’s disease – why we need early diagnosis. Degener Neurol Neuromuscul Dis 2019; 9 123–30.
| Alzheimer’s disease – why we need early diagnosis.Crossref | GoogleScholarGoogle Scholar | 31920420PubMed |
[14] Ma L. Depression, anxiety, and apathy in mild cognitive impairment: current perspectives. Front Aging Neurosci 2020; 12 9.
| Depression, anxiety, and apathy in mild cognitive impairment: current perspectives.Crossref | GoogleScholarGoogle Scholar | 32082139PubMed |
[15] Maki Y. Proposal for the empowerment of interdependent self-management support for people with dementia. J Geriatr Care Res 2019; 6 3–8.
[16] Maki Y, Iritani S, Terada S, et al. Communication support for persons with dementia through ‘self-management of autonomous interdependent life empowerment’. J Geriatr Care Res 2019; 6 56–63.
[17] Cummings J, Lee G, Ritter A, Sabbagh M, Zhong K. Alzheimer’s disease drug development pipeline: 2020. Alzheimers Dement 2020; 6 e12050.
[18] Bahar-Fuchs A, Martyr A, Goh AM, Sabates J, Clare L. Cognitive training for people with mild to moderate dementia. Cochrane Database Syst Rev 2019; 3 CD013069.
| Cognitive training for people with mild to moderate dementia.Crossref | GoogleScholarGoogle Scholar | 30909318PubMed |
[19] Gates NJ, Rutjes AW, Di Nisio M, et al. Computerised cognitive training for maintaining cognitive function in cognitively healthy people in midlife. Cochrane Database Syst Rev 2019; 3 CD012278.
| Computerised cognitive training for maintaining cognitive function in cognitively healthy people in midlife.Crossref | GoogleScholarGoogle Scholar | 30864747PubMed |
[20] van der Steen JT, Smaling HJ, van der Wouden JC, Bruinsma MS, Scholten RJ, Vink AC. Music-based therapeutic interventions for people with dementia. Cochrane Database Syst Rev 2018; 7 CD003477.
| Music-based therapeutic interventions for people with dementia.Crossref | GoogleScholarGoogle Scholar | 30033623PubMed |
[21] Woods B, O’Philbin L, Farrell EM, Spector AE, Orrell M. Reminiscence therapy for dementia. Cochrane Database Syst Rev 2018; 3 CD001120.
| Reminiscence therapy for dementia.Crossref | GoogleScholarGoogle Scholar | 29493789PubMed |
[22] Zucchella C, Sinforiani E, Tamburin S, et al. The multidisciplinary approach to Alzheimer’s disease and dementia: a narrative review of non-pharmacological treatment. Front Neurol 2018; 9 1058.
| The multidisciplinary approach to Alzheimer’s disease and dementia: a narrative review of non-pharmacological treatment.Crossref | GoogleScholarGoogle Scholar | 30619031PubMed |
