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Practice guideline update summary: Mild cognitive impairment [RETIRED]: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology
Open accessAbstract
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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“Among those with MCI, about 15% develop dementia after two years.51”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [51]
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“A systematic review of more than 30 studies of MCI reported that about 17% of people age 65 and older had MCI.51”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [51]
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“Among those with MCI, about 15% develop dementia after two years.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [51]
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“A systematic review of more than 30 studies of all‐cause MCI reported that about 17% of people age 65 and older had MCI.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [51]
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“Based on these findings, the American Academy of Neurology’s published guidelines do not recommend ChEIs for MCI treatment.17”
From A 2025 update on treatment strategies for the Alzheimer’s disease spectrum (2025) · cites this paper as [17]
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“Most anti-Aβ drugs showed the best efficacy on Aβ-positive MCI patients in clinical trials and real-world studies52.”
From Integrated algorithm combining plasma biomarkers and cognitive assessments accurately predicts brain β-amyloid pathology (2023) · cites this paper as [52]
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Metadata
- Authors
- Petersen, R. C., López, O. L., Armstrong, M. J., Getchius, T. S. D., Ganguli, M., Gloss, D. S., Gronseth, G., Marson, D. C., Pringsheim, T. M., Day, G. S., Sager, M. A., Stevens, J., & Rae-Grant, A. D.
- Affiliations
- Mayo Clinic (US)
- ORCID
- Venue
- Neurology
- Published
- 2018-01-16
- Volume
- 90
- Issue
- 3
- Pages
- 126-135
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC5772157
- OpenAlex
- W2780732598
- Cited by
- 2,183
- References
- 48
- Citations by year
- 2026: 232 · 2025: 331 · 2024: 363 · 2023: 305 · 2022: 303 · 2021: 233 · 2020: 210 · 2019: 143 · 2018: 61
- FWCI
- 92.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- mild cognitive impairment, prevalence, dementia incidence, prognosis, pharmacotherapy, cholinesterase inhibitors, exercise training, cognitive training, modifiable risk factors, functional disability, cognitive assessment, biomarkers, older adults
- MeSH terms
- Delphi Technique, Humans, Cognitive Dysfunction
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