Communicating mild cognitive impairment diagnoses with and without amyloid imaging

Joshua D. Grill, Liana G. Apostolova, Szofia Bullain, Jeffrey M. Burns, Chelsea G. Cox, Malcolm Dick, Dean Hartley, Claudia Kawas, Sarah Kremen, Jennifer Lingler, Oscar L. Lopez, Mark Mapstone, Aimee Pierce, Gil Rabinovici, J. Scott Roberts, Seyed Ahmad Sajjadi, Edmond Teng, Jason Karlawish

Research output: Contribution to journalReview article

21 Scopus citations

Abstract

Background: Mild cognitive impairment (MCI) has an uncertain etiology and prognosis and may be challenging for clinicians to discuss with patients and families. Amyloid imaging may aid specialists in determining MCI etiology and prognosis, but creates novel challenges related to disease labeling. Methods: We convened a workgroup to formulate recommendations for clinicians providing care to MCI patients. Results: Clinicians should use the MCI diagnosis to validate patient and family concerns and educate them that the patient's cognitive impairment is not normal for his or her age and education level. The MCI diagnosis should not be used to avoid delivering a diagnosis of dementia. For patients who meet Appropriate Use Criteria after standard-of-care clinical workup, amyloid imaging may position specialists to offer more information about etiology and prognosis. Clinicians must set appropriate expectations, including ensuring that patients and families understand the limitations of amyloid imaging. Communication of negative results should include that patients remain at elevated risk for dementia and that negative scans do not indicate a specific diagnosis or signify brain health. Positive amyloid imaging results should elicit further monitoring and conversations about appropriate advance planning. Clinicians should offer written summaries, including referral to appropriate social services. Conclusions: In patients with MCI, there is a need to devote considerable time and attention to patient education and shared decision-making. Amyloid imaging may be a tool to aid clinicians. Careful management of patient expectations and communication of scan results will be critical to the appropriate use of amyloid imaging information.

Original languageEnglish (US)
Article number35
JournalAlzheimer's Research and Therapy
Volume9
Issue number1
DOIs
StatePublished - May 4 2017

Keywords

  • Amyloid imaging
  • Diagnosis
  • Disclosure
  • Mild cognitive impairment
  • Prognosis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cognitive Neuroscience

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    Grill, J. D., Apostolova, L. G., Bullain, S., Burns, J. M., Cox, C. G., Dick, M., Hartley, D., Kawas, C., Kremen, S., Lingler, J., Lopez, O. L., Mapstone, M., Pierce, A., Rabinovici, G., Roberts, J. S., Sajjadi, S. A., Teng, E., & Karlawish, J. (2017). Communicating mild cognitive impairment diagnoses with and without amyloid imaging. Alzheimer's Research and Therapy, 9(1), [35]. https://doi.org/10.1186/s13195-017-0261-y