Format

Send to

Choose Destination
Alzheimers Res Ther. 2017 May 4;9(1):35. doi: 10.1186/s13195-017-0261-y.

Communicating mild cognitive impairment diagnoses with and without amyloid imaging.

Author information

1
Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA. jgrill@uci.edu.
2
Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA. jgrill@uci.edu.
3
Institute for Memory Impairments and Neurological Disorders, University of California, 3204 Biological Sciences III, Irvine, CA, 92697, USA. jgrill@uci.edu.
4
Alzheimer's Disease Center, Department of Neurology, Radiology, Medical and Molecular Genetics, University of Indiana, Indianapolis, IN, USA.
5
Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
6
Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.
7
Department of Neurology, University of California, Irvine, CA, USA.
8
University of Kansas, Kansas City, KS, USA.
9
Alzheimer's Association, Chicago, IL, USA.
10
University of Pittsburgh, Pittsburgh, PA, USA.
11
University of California, San Francisco, CA, USA.
12
University of Michigan School of Public Health, Ann Arbor, MI, USA.
13
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
14
University of Pennsylvania, Philadelphia, PA, USA.

Abstract

BACKGROUND:

Mild cognitive impairment (MCI) has an uncertain etiology and prognosis and may be challenging for clinicians to discuss with patients and families. Amyloid imaging may aid specialists in determining MCI etiology and prognosis, but creates novel challenges related to disease labeling.

METHODS:

We convened a workgroup to formulate recommendations for clinicians providing care to MCI patients.

RESULTS:

Clinicians should use the MCI diagnosis to validate patient and family concerns and educate them that the patient's cognitive impairment is not normal for his or her age and education level. The MCI diagnosis should not be used to avoid delivering a diagnosis of dementia. For patients who meet Appropriate Use Criteria after standard-of-care clinical workup, amyloid imaging may position specialists to offer more information about etiology and prognosis. Clinicians must set appropriate expectations, including ensuring that patients and families understand the limitations of amyloid imaging. Communication of negative results should include that patients remain at elevated risk for dementia and that negative scans do not indicate a specific diagnosis or signify brain health. Positive amyloid imaging results should elicit further monitoring and conversations about appropriate advance planning. Clinicians should offer written summaries, including referral to appropriate social services.

CONCLUSIONS:

In patients with MCI, there is a need to devote considerable time and attention to patient education and shared decision-making. Amyloid imaging may be a tool to aid clinicians. Careful management of patient expectations and communication of scan results will be critical to the appropriate use of amyloid imaging information.

KEYWORDS:

Amyloid imaging; Diagnosis; Disclosure; Mild cognitive impairment; Prognosis

PMID:
28472970
PMCID:
PMC5418690
DOI:
10.1186/s13195-017-0261-y
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center