Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-26T09:07:37.604Z Has data issue: false hasContentIssue false
  • English
  • Français

What explains variations in the clinical use of mild cognitive impairment (MCI) as a diagnostic category?

Published online by Cambridge University Press:  01 August 2008

Tiago Moreira ,
Julian C. Hughes ,
Thomas Kirkwood ,
Carl May ,
Ian McKeith  and
John Bond
Tiago Moreira*
Affiliation:
School of Applied Social Sciences, University of Durham, U.K.
Julian C. Hughes
Affiliation:
Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, U.K. Northumbria Healthcare NHS Foundation Trust, U.K.
Thomas Kirkwood
Affiliation:
Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, U.K.
Carl May
Affiliation:
Institute for Health and Society, Newcastle University, Newcastle upon Tyne, U.K.
Ian McKeith
Affiliation:
Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, U.K.
John Bond
Affiliation:
Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, U.K. Institute for Health and Society, Newcastle University, Newcastle upon Tyne, U.K.
*
Correspondence should be addressed to: Tiago Moreira, School of Applied Social Sciences, University of Durham, 32 Old Elvet, Durham, DH1 3HN, U.K. Phone: +44 191 3346843. Fax: +44 191 3346821. Email: tiago.moreira@durham.ac.uk.
Get access

Abstract

Background: Mild cognitive impairment (MCI) is proposed to describe the transitional stage between normal cognitive aging and dementia. It has had significant impact in the field of dementia research, but it remains controversial whether or not it should be used as a diagnostic category in clinical practice.

Methods: Semi-structured interviews were carried out with international experts (N = 37) in the field of dementia research and practice. These interviews explored the advantages and difficulties of using MCI as a clinical diagnosis.

Results: There is wide variation in the clinical use of MCI. This variation depends on institutional factors and two types of cultural factors: (a) clinical culture, and (b) the “evidential culture” – how research and guidelines figure in clinical practice.

Conclusion: The study shows the importance of combining values-based practice with evidence-based practice in the early diagnosis of dementia.

Keywords

mild cognitive impairmentclinical diagnosisclinical practiceinstitutional factorsvalues-based practice
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 4 , August 2008 , pp. 697 - 709
Copyright
© International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blaxter, M. (1978). Diagnosis as category and process - case of alcoholism. Social Science and Medicine, 12, 9–17.Google Scholar
Brayne, C., Gao, L., Dewey, M., Matthews, F. E.and Medical Research Council Cognitive Function and Ageing Study Investigators (2006). Dementia before death in ageing societies—the promise of prevention and the reality. PLoS Medicine/Public Library of Science, 3, e397. DOI: 10.1371/journal.pmed.0030397.Google ScholarPubMed
Brown, P. (1995). Naming and framing: the social construction of diagnosis and illness. Journal of Health and Social Behavior, 35, 34–52.CrossRefGoogle Scholar
Corner, L. and Bond, J. (2006). The impact of the label of mild cognitive impairment on the individual's sense of self. Philosophy, Psychiatry and Psychology, 13, 3–12CrossRefGoogle Scholar
Fulford, K. W. M. (2004). Facts/values: ten principles of values-based medicine. In: Radden, J. (ed.), The Philosophy of Psychiatry: A Companion (pp. 205–234). Oxford: Oxford University Press.Google Scholar
Gaines, A. D. and Whitehouse, P. J. (2006). Building a mystery: Alzheimer's disease, mild cognitive impairment, and beyond. Philosophy, Psychiatry and Psychology, 13, 61–74.CrossRefGoogle Scholar
Gauthier, S. et al. (2006). Mild cognitive impairment. Lancet, 367, 1262–1270.CrossRefGoogle ScholarPubMed
Gauthier, S. and Touchon, J. (2005). Mild cognitive impairment is not a clinical entity and should not be treated. Archives of Neurology, 62, 1164–1166; discussion 1167.CrossRefGoogle Scholar
Graham, J. E. and Ritchie, K. (2006). Mild cognitive impairment: ethical considerations for nosological flexibility in human kinds. Philosophy, Psychiatry and Psychology, 13, 31–43.CrossRefGoogle Scholar
Kirkwood, T. (2006). Alzheimer's disease, mild cognitive impairment, and the biology of intrinsic ageing. Philosophy, Psychiatry and Psychology, 13, 79–82.CrossRefGoogle Scholar
Lingler, J. H., et al. (2006). Making sense of mild cognitive impairment: a qualitative exploration of the patient's experience. The Gerontologist, 46, 791–800.CrossRefGoogle ScholarPubMed
Malterud, K. (2001). Qualitative research: standards, challenges, and guidelines. Lancet, 358, 483–488.CrossRefGoogle ScholarPubMed
May, C. (2001). Pathology, identity and the social construction of alcohol dependence. Sociology, 35, 385–401.CrossRefGoogle Scholar
May, C. (2006). A rational model for assessing and evaluating complex interventions in health care. BMC Health Services Research, 6, 86.CrossRefGoogle ScholarPubMed
Mays, N. and Pope, C. (1996). Qualitative Research in Health Care. London: British Medical Journal Publishing Group.Google Scholar
Mol, A. and Elsman, B. (1996). Detecting disease and designing treatment. duplex and the diagnosis of diseased leg vessels. Sociology of Health and Illness, 18, 609–631.CrossRefGoogle Scholar
Moreira, T. (2005). Diversity in clinical guidelines: the role of repertoires of evaluation. Social Science and Medicine, 60, 1975–1985.CrossRefGoogle ScholarPubMed
Moreira, T. in press. Testing promises:truth and hope in drug development and evaluation in Alzheimer's disease. In: Ballenger, J. F., Whitehouse, P. J., Lyketsos, C., Rabins, P. and Karlawish, J. H. T. (eds.), Do We Have a Pill for That? Interdisciplinary Perspectives on the Development, Use and Evaluation of Drugs in the Treatment of Dementia. Baltimore: Johns Hopkins University Press.Google Scholar
Moreira, T., Hughes, J., Kirkwood, T., May, C., McKeith, I. and Bond, J. (2006). Boundary Work, Normal Ageing, and Brain Pathology: End of Award Report, Science in Society Programme. Newcastle: Newcastle University.Google Scholar
Petersen, R. C. (2006). Mild cognitive impairment[comment]. Lancet, 367, 1979.CrossRefGoogle ScholarPubMed
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Kokmen, E. and Tangelos, E. G. (1997). Aging, memory, and mild cognitive impairment. International Psychogeriatrics, 9, Suppl.CrossRefGoogle ScholarPubMed
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303.CrossRefGoogle ScholarPubMed
Petersen, R. C. et al. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58, 1985–1992.CrossRefGoogle ScholarPubMed
Whitehouse, P. and Brodaty, H. (2006). Mild cognitive impairment. Lancet, 367, 1979.CrossRefGoogle ScholarPubMed
Whitehouse, P. J. and Juengst, E. T. (2005). Antiaging medicine and mild cognitive impairment: practice and policy issues for geriatrics. Journal of the American Geriatrics Society, 53, 1417–1422.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment–beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar