Physician Diagnosis and Knowledge of Mild Cognitive Impairment

2021 ◽  
pp. 1-10
Author(s):  
Emilie M. Blair ◽  
Darin B. Zahuranec ◽  
Jane Forman ◽  
Bailey K. Reale ◽  
Kenneth M. Langa ◽  
...  

Background: Older adults with mild cognitive impairment (MCI) receive fewer guideline-concordant treatments for multiple health conditions than those with normal cognition. Reasons for this disparity are unclear. Objective: To better understand this disparity, we describe physician understanding and experience with patient MCI, particularly physician identification of MCI, ability to distinguish between MCI and dementia, and perspectives on education and training in MCI and dementia. Methods: As part of a mixed-methods study assessing the influence of patient MCI on physician recommendations for acute myocardial infraction and stroke treatments, we conducted a descriptive qualitative study using semi-structured interviews of physicians from three specialties. Key question topics included participants’ identification of MCI, impressions of MCI and dementia awareness within their practice specialty, and perspectives on training and education in MCI. Results: The study included 22 physicians (8 cardiologists, 7 neurologists, and 7 internists). We identified two primary themes: There is 1) a lack of adequate understanding of the distinction between MCI and dementia; and 2) variation in physician approaches to identifying whether an older adult has MCI. Conclusion: These findings suggest that physicians have a poor understanding of MCI. Our results suggest that interventions that improve physician knowledge of MCI are needed.

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Bailey K Reale ◽  
Darin B Zahuranec ◽  
Kenneth M Langa ◽  
Jane Forman ◽  
Bruno Giordani ◽  
...  

2008 ◽  
Vol 20 (4) ◽  
pp. 697-709 ◽  
Author(s):  
Tiago Moreira ◽  
Julian C. Hughes ◽  
Thomas Kirkwood ◽  
Carl May ◽  
Ian McKeith ◽  
...  

ABSTRACTBackground: Mild cognitive impairment (MCI) is proposed to describe the transitional stage between normal cognitive aging and dementia. It has had significant impact in the field of dementia research, but it remains controversial whether or not it should be used as a diagnostic category in clinical practice.Methods: Semi-structured interviews were carried out with international experts (N = 37) in the field of dementia research and practice. These interviews explored the advantages and difficulties of using MCI as a clinical diagnosis.Results: There is wide variation in the clinical use of MCI. This variation depends on institutional factors and two types of cultural factors: (a) clinical culture, and (b) the “evidential culture” – how research and guidelines figure in clinical practice.Conclusion: The study shows the importance of combining values-based practice with evidence-based practice in the early diagnosis of dementia.


Author(s):  
Masako Nakano ◽  
Shinichi Sato ◽  
Jun Nakahara

This study aimed to clarify the emotional experiences of a community-dwelling sample of elderly individuals with mild cognitive impairment and their families. The participants included an elderly man and his wife and an elderly woman and her daughterin- law. Data were collected using semi-structured interviews and analyzed by using a qualitative inductive method. In total, 212 codes were extracted from the interviews and categorized into 37 sub-categories. Finally, we obtained the following 4 categories: Bewilderment regarding memory decline, Avoidance of neighborly relations, Fluctuation of confidence in the family, and Desire to maintain a healthy life.


2020 ◽  
Vol 8 ◽  
pp. 205031212090457
Author(s):  
Sarah Gregory ◽  
Jo Billings ◽  
Danielle Wilson ◽  
Gill Livingston ◽  
Anne GM Schilder ◽  
...  

Objectives: Hearing aid usage supports communication and independence; however, many do not use their hearing aids. This study explored the experiences of hearing aid use in adults with mild cognitive impairment or Alzheimer’s disease. Methods: Participants completed semi-structured interviews which were analysed using thematic analysis. Ten people (six males, age range 75–86 years old) with mild cognitive impairment or Alzheimer’s disease who had been fitted with hearing aids were recruited to the study. Results: We identified four major themes: (1) memory and other cognitive barriers to using hearing aids, (2) practical aspects of hearing aids, (3) benefits of hearing aids, and (4) ambivalence towards hearing aids. Conclusions: Participants perceived a significant impact of cognitive impairment on the experience of using hearing aids. This population may benefit from targeted strategies to support use of hearing aids. The findings from this study can inform future research to optimise use of hearing aids in this population.


2010 ◽  
Vol 22 (4) ◽  
pp. 629-640 ◽  
Author(s):  
Fulvia Di Iulio ◽  
Katie Palmer ◽  
Carlo Blundo ◽  
Anna Rosa Casini ◽  
Walter Gianni ◽  
...  

ABSTRACTBackground: Neuropsychiatric disorders are common in cognitively impaired older persons, and associated with institutionalization and caregiver stress in Alzheimer's disease (AD). Few studies have compared the occurrence of both psychiatric disorders and neuropsychiatric symptoms in patients with AD and mild cognitive impairment (MCI) subtypes. We aimed to investigate the frequency of psychiatric disorders and neuropsychiatric symptoms in AD and MCI patients, compared to controls.Methods: We included 245 outpatients of a memory clinic in Rome, Italy (119 AD; 68 multidomain-MCI; 58 amnestic-MCI) and 107 controls. Categorical disorders of depression and apathy were diagnosed with structured interviews. Symptoms were evaluated with the Neuropsychiatric Inventory (NPI). The odds ratios (OR) of patients having neuropsychiatric symptoms compared to controls were calculated with logistic regression, adjusted for sociodemographic and clinical variables.Results: A large proportion of AD (49.6%) and multidomain-MCI (44.1%) patients had depression disorder. Apathy disorder was common in AD (51.3%) but less frequent in amnestic-MCI (6.9%) and multidomain-MCI (14.7%). AD patients were three times more likely to have depression disorders (OR = 3.0, CI = 1.1–7.6) or apathy (OR = 16.9, CI = 4.6–61.8) compared to amnestic-MCI, and seven times more likely to have apathy disorder than multidomain-MCI (OR = 7.5, CI = 3.0–19.2). After apathy and depression, the most prevalent neuropsychiatric symptoms in AD and MCI were anxiety, agitation, irritability, night-time behaviors, and appetite disturbances. There was an increasing prevalence of many neuropsychiatric symptoms with increasing severity of cognitive syndromes.Conclusions: Clinicians should consider the relevance of neuropsychiatric disorders and symptoms in patients with cognitive disturbances, and incorporate a thorough psychiatric examination in the evaluation of patients.


2013 ◽  
Vol 26 (3) ◽  
pp. 475-485 ◽  
Author(s):  
Katherine Dean ◽  
Crispin Jenkinson ◽  
Gordon Wilcock ◽  
Zuzana Walker

ABSTRACTBackground:The aim of this study was to investigate the experiences of people with mild cognitive impairment (MCI; PWMCI) and their “advocates,” particularly within healthcare services.Methods:Semi-structured interviews were conducted with 23 PWMCI diagnosed ≤6 months ago and 20 advocates recruited via patients. The resulting data were content-analyzed.Results:PWMCI interviewed rarely reported negative impressions of their general practitioner (GP). Reports regarding memory services were more mixed: positive impressions related to finding the service to be “well run” and the staff “pleasant,” negative ones to the assessment process or a perceived lack of feedback. Aside from improved information provision, most PWMCI had no suggestions for improvements to their healthcare. However, these results should be interpreted with caution as many of the PWMCI interviewed displayed evidence of impaired recall and/or insight relating to their condition and healthcare. Advocates generally reported more negative impressions of both contact with the PWMCI's GP (most commonly reporting a “dismissive” attitude) and memory services (with common complaints relating to the assessments used in clinics and lengthy waiting times). This group generally had suggestions for improvements to services – particularly regarding information provision, changes in the assessment process, and improvements in communication by services.Conclusions:To our knowledge, this is the first in-depth study of the difficulties experienced by PWMCI and their advocates which includes the context of healthcare provision. The specific needs of these groups, as described here, as well as those of people with dementia, should be considered when designing memory clinics and other related services.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 878-878
Author(s):  
Kara Cohen ◽  
Tracy Mitzner ◽  
Patricia Griffiths

Abstract Individuals with Mild Cognitive Impairment (MCI) may have limited access to intervention programs that support their mental and physical health. The COVID-19 pandemic has put them at an even greater risk of not having access to such programs. While there is currently no cure, there is growing evidence that intervention programs may attenuate the progression from MCI to dementia, particularly those which 1) have potential to reduce the level of cardiovascular risk factors, 2) employ cognitively stimulating activities, and 3) create opportunities for social interaction (Petersen, Lopez, Armstrong et al., 2018; Wayne, Yeh, & Mehta, 2018; Mortimer, Ding, Borenstein et al., 2012). Many mind-body interventions, such as tai chi, yoga, and mindfulness classes, contain these three elements and have been shown to benefit individuals diagnosed with MCI, including improving cognition (e.g., Wells, Kerr, Wolkin, et al. 2013; Yang, 2016). Tele-technology (i.e., technology that supports communication between people who are not co-located) can aid in overcoming the logistical barriers by bringing instructors and interventions to these individuals to help them stay engaged and attend activities more frequently from the comfort and convenience of their home. We will present recent findings from a user study with 8 stakeholders (4 subject matter experts, 2 individuals with MCI, 2 care partners) to assess barriers and facilitators to using tele-technology to bring instruction of mind-body interventions to individuals diagnosed with MCI. This poster will present guidelines for delivering such interventions based on our findings from the user study, including safety and training protocols.


2014 ◽  
Vol 19 (2) ◽  
pp. 72-77
Author(s):  
Renee Kinder

Appropriate coding when providing skilled therapy interventions for individuals with Mild Cognitive Impairment (MCI) begins by obtaining an adequate understanding of the diagnostic criteria for the disorder. Current diagnostic criteria for MCI include: a. reported change in cognition, which is preferably corroborated by an informant in comparison with previous level with concern of patient, family, or clinician with one or more impaired cognitive domains for age and education. b. decline which is evident over time and greater than expected for age and education in a variety of domains including memory, executive function, attention, language, visuospatial skills, and episodic memory. c. not normal, not demented. d. intact activities of daily living (Albert et al., 2011). Individual may present with mild problems with complex tasks such as paying bills, preparing a meal, and shopping and may require more time and be less efficient, with more errors during tasks.


Dementia ◽  
2017 ◽  
Vol 19 (2) ◽  
pp. 518-527 ◽  
Author(s):  
Juan Tortosa-Martínez ◽  
Vicente J Beltrán-Carrillo ◽  
Nuria Caus ◽  
Marcos J Iglesias-Martínez ◽  
Inés Lozano-Cabezas ◽  
...  

The aim of this study was to explore the perceived psychosocial benefits of a three-month exercise program for 10 older adults with amnestic Mild Cognitive Impairment, a condition in which memory loss is the main symptom. Qualitative data were collected by observation (research diary) and 20 semi-structured interviews with the participants (10) and their caregivers (10). The narratives showed remarkable psychosocial benefits, such as improved mood, motivation, autonomy, perceived competence, self-esteem, and social relationships. The results of this study should provide new insights into the importance of exercise for this population, and may help to design appropriate programs for them.


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