Mild cognitive impairment: the Manchester consensus

Ross A Dunne*, Dag Aarsland, John T O'Brien, Clive Ballard, Sube Banerjee, Nick C Fox, Jeremy D Isaacs, Benjamin R Underwood, Richard J Perry, Dennis Chan, Tom Dening, Alan J Thomas, Jeffrey Schryer, Anne-Marie Jones, Alison R Evans, Charles Alessi, Elizabeth J Coulthard, James Pickett, Peter Elton, Roy W JonesSusan Mitchell, Nigel Hooper, Chris Kalafatis, Jill G C Rasmussen, Helen Martin, Jonathan M Schott, Alistair Burns

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5–15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer’s disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI.



Original languageEnglish
Pages (from-to)72-80
Number of pages9
JournalAge and Ageing
Volume50
Issue number1
DOIs
Publication statusPublished - 17 Nov 2020

Keywords

  • mild cognitive impairment
  • dementia
  • biomarkers
  • amyloid
  • tau
  • CSF
  • clinical trials
  • risk reduction
  • cerebrovascular
  • neurodegeneration
  • Alzheimer's
  • Lewy body
  • neuropsychology
  • neuroimaging
  • older people

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