Mild Cognitive Impairment: the Manchester consensus

Abstract

Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in mild cognitive impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5–15% of people developing dementia per year. However, ~50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that these may also help guide prognosis. Diagnostic criteria allow for a diagnosis of Alzheimer’s disease to be made where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single disease marker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI.

Validity and Cultural Generalisability of a 5-Minute AI-Based, Computerised Cognitive Assessment in Mild Cognitive Impairment and Alzheimer's Dementia

“…Computerised cognitive tests constitute promising tools for the early detection of clinically relevant changes in MCI and AD sufferers (7,(16)(17)(18). Computer and mobile device-based tests have been investigated to some extent, with several showing good diagnostic accuracy entering clinical use (13,19,20).…”

“…Furthermore, such tests are able to benefit from advanced analytics for more accurate and personalised results. Artificial intelligence (AI) and machine learning are being increasingly used for applications in Dementia research (7). These tools have also been applied to detection of dementia using electronic health records and neuroimaging data (22)(23)(24).…”

Validity and cultural generalisability of a 5-minute AI-based, computerised cognitive assessment in Mild Cognitive Impairment and Alzheimer’s Dementia

“…4 In anticipation of disease-modifying treatments for MCI and AD, 5,6 the importance of early diagnosis has become increasingly pressing. 7 There is accumulating evidence that early detection provides cost savings for health care systems and is an achievable goal, 8,9 and accurate patient selection for disease-modifying treatments is cost-effective and will improve clinical outcomes. 5 Timely identification and diagnosis is considered to be key to tackling dementia offering multiple benefits to patients, families and caregivers, healthcare providers, as well as society as a whole.…”

“…Computerized cognitive tests constitute promising tools for the early detection of clinically relevant changes in MCI and AD sufferers. 7,[16][17][18] Computer and mobile device-based tests have been investigated to some extent, with several showing good diagnostic accuracy entering clinical use. 13,19,20 Devices such as smartphones and tablets offer a nearly unlimited number of applications that can be combined for the comprehensive assessment of cognition and brain health in community-dwelling users.…”

“…Artificial intelligence (AI) and machine learning are being increasingly used for applications in Dementia research. 7 These tools have also been applied to detection of dementia using electronic health records and neuroimaging data. [22][23][24] Recent evidence suggests that three-quarters of older people are open to new technology to make an accurate and early diagnosis and would agree to using computer or smartphone tasks that monitor day-to-day life.…”