chapter  43
Managing the patient with mild cognitive impairment
ByNicola T. Lautenschlager, Alexander F. Kurz
Pages 7

Obviously, the individual clinical presentation, medical history and available evidence on the underlying cause will determine how the diagnosis should be disclosed to the patient and family and what prognostic advice is to be given. MCI as a diagnosis oen has a dierent meaning for a patient from a family with familial AD as compared to someone who has no family history of cognitive impairment. Many specialists inform the patient and next of kin about the many unknown elements surrounding the MCI ‘label’ and the fact that research in this area is still a work in progress (Petersen, 2007) and this openness is usually appreciated. Where available and appropriate, the question of prognosis might make it relevant to educate patients and family members about the potential usefulness of biomarkers, which can help with estimating the risk for clinical deterioration. Structural magnetic resonance imaging (MRI) is recommended when considering a clinical diagnosis of MCI and can assist with estimating the underlying pathologies contributing to the clinical presentation as well as the risk for clinical deterioration in the near future. However, more standardization and international guidelines are needed for the clinical context (Petersen et al., 2001; Jack et al., 2009; Jack et al., 2010; Jack et al., 2011; Petersen, 2011). Functional imaging, such as f ludeoxyglucose or more recently, carbon-11-labelled Pittsburgh compound B or orbetapir positron emission tomography (PET) can give an indication as to what extent AD pathology is present and might impact on prognosis (Small et al., 2008; Johnson et al., 2013; Villemagne et al., 2013). Another biomarker of relevance is low cerebrospinal uid (CSF) Aβ42, which has been shown to have some predictive potential for future progression towards dementia; however, a routine lumbar puncture as part of diagnostic and management procedures for MCI is currently not recommended for many countries (Mattsson et al., 2009; Petersen, 2009; see Chapter 42 for more information on biomarkers and MCI).