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The concept of mild cognitive impairment (MCI) presents quandaries on several levels. Is it a clearly defined syndrome? A stage of Alzheimer disease (AD)? The prodromal phase preceding AD? The prodromal stage before any dementia? What is the relationship between memory impairment and involvement of other cognitive domains? Should accurate diagnosis move beyond subjective and objective evidence of cognitive impairment, to allow consideration of genetic susceptibility to AD or imaging and biochemical evidence of amyloidosis?
Whatever MCI is, it is surely a prevalent, important clinical problem. In the therapeutic age of AD that began 15 years ago, more individuals seek evaluation at early stages of impairment. The clinician may be uncertain of the best label (though MCI often seems preferable to very early AD; it is less foreboding, more palatable, gentler), but a number of interventions seem appropriate and are widely practiced. The most important is education of patient and family regarding the risks, appropriate safety measures (limiting or halting driving, limiting some responsibilities, providing supervision), and planning (occupational, health, financial, legal, care). Clinicians commonly offer general recommendations …
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