Assessing and disclosing test results for MCI: The perspective of UK old age psychiatrists

Abstract

AbstractBackgroundMild cognitive impairment (MCI) is a state between normal healthy ageing and dementia with an uncertain prognosis. This uncertainty creates a complex dynamic between the clinicians’ conception of MCI, what is communicated to the individual about their condition, and how the individual perceives the information conveyed to them. The aim of this study was to explore clinicians’ views around the assessment and communication of MCI in memory clinics.MethodAs part of a larger longitudinal study looking at patients’ adjustment to being told they have MCI, we interviewed Old Age Psychiatrists at the five participating sites across South‐East Scotland. The study obtained ethics approvals and the interviews (carried out between Nov 2020–Jan 2021) followed a semi‐structured schedule focusing on [1] how likely clinicians are to use the term MCI with patients; [2] what tests clinicians rely on and how much utility they see in them; and [3] how clinicians communicate risk of conversion to dementia. The interviews were voice recorded and will be analysed using reflective thematic analysis (Clarke and Braun, 2019).ResultInitial results show that most clinicians interviewed (Total N=19) felt MCI had significant limitations as a diagnostic label. Nevertheless, more clinicians reported using the term MCI (n=15) with patients than not (n=4). Clinical history was commonly described as the primary aid in the diagnostic process and also to rule out functional impairment (which was sometimes corroborated by Occupational Therapy assessment). All clinicians reported using the Addenbrooke's Cognitive Examination‐Revised as a primary assessment tool; neuroimaging (e.g., CT) was frequently found to have minimal usefulness due to the reports being non‐specific.ConclusionOur study revealed a mixture of approaches to assessing and disclosing test results for MCI. Some clinicians consider the condition as a separate entity among neurodegenerative disorders whereas others find the term unhelpful due to its poor prognosis. Clinicians report a lack of specific and sensitive assessment methods for identifying MCI in clinical practice. Our study demonstrates a broad range of views and therefore variability in MCI risk disclosure in memory assessment services which may impact on the management of individuals with MCI.