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      • Record: found
      • Abstract: found
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      Practice guideline update summary: Mild cognitive impairment : Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology

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          Abstract

          Objective

          To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI).

          Methods

          The guideline panel systematically reviewed MCI prevalence, prognosis, and treatment articles according to AAN evidence classification criteria, and based recommendations on evidence and modified Delphi consensus.

          Results

          MCI prevalence was 6.7% for ages 60–64, 8.4% for 65–69, 10.1% for 70–74, 14.8% for 75–79, and 25.2% for 80–84. Cumulative dementia incidence was 14.9% in individuals with MCI older than age 65 years followed for 2 years. No high-quality evidence exists to support pharmacologic treatments for MCI. In patients with MCI, exercise training (6 months) is likely to improve cognitive measures and cognitive training may improve cognitive measures.

          Major recommendations

          Clinicians should assess for MCI with validated tools in appropriate scenarios (Level B). Clinicians should evaluate patients with MCI for modifiable risk factors, assess for functional impairment, and assess for and treat behavioral/neuropsychiatric symptoms (Level B). Clinicians should monitor cognitive status of patients with MCI over time (Level B). Cognitively impairing medications should be discontinued where possible and behavioral symptoms treated (Level B). Clinicians may choose not to offer cholinesterase inhibitors (Level B); if offering, they must first discuss lack of evidence (Level A). Clinicians should recommend regular exercise (Level B). Clinicians may recommend cognitive training (Level C). Clinicians should discuss diagnosis, prognosis, long-term planning, and the lack of effective medicine options (Level B), and may discuss biomarker research with patients with MCI and families (Level C).

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          Author and article information

          Contributors
          Ronald C. Petersen:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. NONE

          Patents:

          1. NONE

          Publishing Royalties:

          1. Mild Cognitive Impairment,Oxford University Press, 2003

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. (1) Roche Incorporated, (2) Merck, (3) Genentech, (4) Biogen

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. National Institute on Aging: U01-AG006786 (PI) (1986-present) P50-AG016574 (PI) (1990-present) U01-AG024904 (PI) (2004-present) U01 AG016976 (PI) (1989 ? present)

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Oscar Lopez:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. NONE

          Patents:

          1. NONE

          Publishing Royalties:

          1. NONE

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. Lundbeck,Grifols

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. NIA: P50 AG05133-29; 1P01-AG025204-04

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Melissa J. Armstrong:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. (1) Neurology, Level of Evidence Editorial Board, 2012- current

          Patents:

          1. NONE

          Publishing Royalties:

          1. (1) Parkinson's Disease: Improving Patient Care, Oxford University Press, 2014

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. (1) American Academy of Neurology Evidence-Based Medicine Methodology Consultant

          Speakers' Bureaus:

          1. NONE

          Other activities:

          1. (1) Medscape CME (2016 writing, speaking honoraria)

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. (1) ARHQ, K08HS024159, PI, 2015-2020

          Research Support, Academic Entities:

          1. (1) TBI Endpoints Development Initiative (2016-2017)

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Thomas S.D. Getchius:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. March 2017: Received reimbursement for faculty travel expenses to the New York Academy of Medicine.

          Editorial Boards:

          1. NONE

          Patents:

          1. NONE

          Publishing Royalties:

          1. NONE

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. NONE

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. NONE

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Mary Ganguli:
          Comment :

          Scientific Advisory Boards:

          1. (1)DSMB for National Institute on Aging, grant # AG045157 to Indiana University,

          Gifts:

          1. NONE

          Funding for travel or speaker honoraria:

          1. (1) Alzheimer Association, travel to Alzheimer Association International Conference.

          Editorial Boards:

          1. (1) Journal of the American Geriatrics Society, Associate Editor, 2008-present. (2) International Psychogeriatrics, Associate Editor, 1996-present. (3) Alzheimer Disease and Associated Disorders, Editorial Board member, 2011-present.

          Patents:

          1. NONE

          Publishing Royalties:

          1. NONE

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. NONE

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. (1) National Institute on Aging, K07 AG044395, 2003-2013 (2) National Institute on Aging, R01 AG023651, 2013-2018

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          David Gloss:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. Neurology, LOE Review Team

          Patents:

          1. NONE

          Publishing Royalties:

          1. (1) Neurology for the Specialty Boards, Lippincott Williams and Wilkins, 2006

          Employment, Commercial Entity:

          1. (1) Charleston Area Medical Center, Charleston, WV 25311

          Consultancies:

          1. (1) I am an Evidence-based medicine consultant for the American Academy of Neurology

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. NONE

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Gary S. Gronseth:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. (1) Neurology Now, Editorial advisory board, Inception- Present (2) Neurology, Associate Editor, 2013-Present

          Patents:

          1. NONE

          Publishing Royalties:

          1. NONE

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. NONE

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. NONE

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. American Academy of Neurology

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Daniel Marson:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. NONE

          Patents:

          1. NONE

          Publishing Royalties:

          1. Dr. Marson received an initial honoraria upon signing agreement for writing book entitled: (1) Clinical and Forensic Assessment of Financial Capacity; Publisher: Oxford University Press; Expected publication date 2018

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. (1) Consultant for Janssen Pharmaceuticals

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. (1) NIH grant AG021927 (2004-present, PI) (2) Funded as ADNI site PI for AG24904 (2004-2016) (3) NIH grant AG045154; co-investigator (08/15/14-present)

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. (1) Inventor of Financial Capacity Instrument and Financial Capacity Instrument--Short Form which are both owned by UAB Research Foundation. Have received part of a licensing fee payment received by UABRF for providing the FCI-SF to a company in a clinical trial. (2) Co-inventor of CCTI assessment instrument which is owned by UAB Research Foundation. (1996-present).

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. Provided consultation: State Farm v. Kercinick (2015-2017)(expert witness for plaintiff) Fidelity National Title v. Whitley (2015)(expert witness of plaintiff)

          Tamara Pringsheim:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. Neurology Clinical Practice, Editorial Board Member, 2016, 2017 Canadian Journal of Psychiatry, Editorial Board Member, 2016, 2017

          Patents:

          1. NONE

          Publishing Royalties:

          1. NONE

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. NONE

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. (1) Canadian Institutes of Health Research, Principal Investigator 2014/2015; Co-investigator 2016-2018 (2) Sick Kids Foundation, Principal Investigator, 2013-2018 (3) Alberta Mental Health Strategic Clinical Network, 2014-2016

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Gregory S. Day:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. Serve as an ad-hoc Editor for DynaMed (online evidence- based medicine resource; 2016-ongoing) for content related to dementia.

          Patents:

          1. NONE

          Publishing Royalties:

          1. NONE

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. NONE

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. Avid Pharmaceuticals (provision of radiotracer for ongoing research study).

          Research Support, Government Entities:

          1. NONE

          Research Support, Academic Entities:

          1. 1. Barnes Jewish Hospital Foundation

          Research Support, Foundations and Societies:

          1. 1. American Brain Foundation, Clinical Research Training Fellowship (2016-17) 2. Eugene M Johnson Jr, Weston Brain Institute Postdoctoral Fellowship (2015 Recipient) Stock/Stock Options, Medical Equipment & Materials: 1) Hold stocks (>$10,000) in ANI Pharmaceuticals (a generic pharmaceutical company; 2015 onward).

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Mark Sager:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. NONE

          Patents:

          1. NONE

          Publishing Royalties:

          1. NONE

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. NONE

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. NONE

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          James Stevens:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. NONE

          Patents:

          1. NONE

          Publishing Royalties:

          1. NONE

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. NONE

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. NONE

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. Sanofi-Aventis, Biogen, Lilly, Flamel

          Research Support, Government Entities:

          1. NONE

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Alexander Rae-Grant:
          Comment :

          Scientific Advisory Boards:

          1. NONE

          Gifts:

          1. NONE

          Funding for Travel or Speaker Honoraria:

          1. NONE

          Editorial Boards:

          1. Neurology, Evidence Review Team, 2011-2017

          Patents:

          1. NONE

          Publishing Royalties:

          1. Handbook of Multiple Sclerosis, Springer Healthcare, 2010 Comprehensive review of clinical neurology, Wolters Kluwer, 2012 5 minute consult in neurology, Wolters Klower, 2012 Comprehensive review of clinical neurology second edition, LWW, 2016 Ultimate review of neurology DEMOS 2016 Multiple Sclerosis and Related disorders, DEMOS, 2014

          Employment, Commercial Entity:

          1. NONE

          Consultancies:

          1. NONE

          Speakers' Bureaus:

          1. NONE

          Other Activities:

          1. I edit neurology chapters for dynamic medical, an online text book of medicine which is funded via library subscriptions and receive a fee for work provided. involved in a clinical trial of biotin for multiple sclerosis with MedDay (no personal remuneration)

          Clinical Procedures or Imaging Studies:

          1. NONE

          Research Support, Commercial Entities:

          1. NONE

          Research Support, Government Entities:

          1. CO-PI 4% effort FMRI as an imaging biomarker for preclinical Alzheimer's disease, 2013-2017 NIH grant #A6022304

          Research Support, Academic Entities:

          1. NONE

          Research Support, Foundations and Societies:

          1. NONE

          Stock/Stock Options/Board of Directors Compensation:

          1. NONE

          License Fee Payments, Technology or Inventions:

          1. NONE

          Royalty Payments, Technology or Inventions:

          1. NONE

          Stock/Stock Options, Research Sponsor:

          1. NONE

          Stock/Stock Options, Medical Equipment & Materials:

          1. NONE

          Legal Proceedings:

          1. NONE

          Journal
          Journal ID (nlm-ta): Neurology
          Journal ID (iso-abbrev): Neurology
          Journal ID (hwp): neurology
          Journal ID (publisher-id): neur
          Journal ID (pmc): neurology
          Journal ID (publisher-id): NEUROLOGY
          Title: Neurology
          Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
          ISSN (Print): 0028-3878
          ISSN (Electronic): 1526-632X
          Publication date (Print): 16 January 2018
          Publication date PMC-release: 16 January 2019
          Volume: 90
          Issue: 3
          Pages: 126-135
          Affiliations
          From the Department of Neurology (R.C.P.), Mayo Clinic, Rochester, MN; Department of Neurology (O.L.), University of Pittsburgh Medical Center, PA; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Heart Rhythm Society (T.S.D.G.), Washington, DC; Department of Psychiatry (M.G.), University of Pittsburgh, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City; Department of Neurology (D.M.), University of Alabama, Birmingham; Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Knight Alzheimer Disease Research Center (G.S.D.), Washington University School of Medicine, St. Louis, MO; Wisconsin Alzheimer's Institute (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison; Department of Neurology (J.S.), Fort Wayne Neurological Center, IN; and Department of Neurology (A.R.-G.), Cleveland Clinic, OH.
          Author notes
          Correspondence American Academy of Neurology guidelines@ 123456aan.com

          Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

          Approved by the Guideline Development, Dissemination, and Implementation Subcommittee on July 16, 2016; by the Practice Committee on August 22, 2016; and by the AAN Institute Board of Directors on October 5, 2017.

          This guideline was endorsed by the Alzheimer's Association on May 1, 2017.

          Article
          Accession ID: PMC5772157 Pmcid ID: PMC5772157 Pmc-uid ID: 5772157 Publisher ID: NEUROLOGY2017804898
          DOI: 10.1212/WNL.0000000000004826
          PMC ID: 5772157
          PubMed ID: 29282327
          SO-VID: d17f7539-6c5f-4329-9a3a-ca2f26aed660
          Copyright © Copyright © 2017 American Academy of Neurology
          History
          Date received : 24 February 2017
          Date accepted : 22 September 2017
          Categories
          Subject: 25
          Subject: 39
          Subject: Special Article

          Data availability:

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