Physician Diagnosis and Knowledge of Mild Cognitive Impairment

Article type: Research Article

Authors: Blair, Emilie M.^a | Zahuranec, Darin B.^{a; b} | Forman, Jane^{a; c} | Reale, Bailey K.^a | Langa, Kenneth M.^{a; c; d; e} | Giordani, Bruno^f | Fagerlin, Angela^g | Kollman, Colleen^h | Whitney, Rachael T.^a | Levine, Deborah A.^{a; b; d; *}

Affiliations: [a] Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA | [b] Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, USA | [c] VA Ann Arbor Healthcare System, Ann Arbor, MI, USA | [d] Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA | [e] Institute for Social Research, University of Michigan, Ann Arbor, MI, USA | [f] Department of Psychiatry & Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI, USA | [g] Department of Population Health Sciences, UT and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, University of Utah, Salt Lake City, UT, USA | [h] Kollman Research Services, Ann Arbor, MI, USA

Correspondence: [*] Correspondence to: Deborah A. Levine, MD, MPH, University of Michigan Division of General Medicine, North Campus Research Complex, 2800 Plymouth Road, 16-4, Ann Arbor, MI 48109-2800, USA. Tel.: +1 734 936 5216; E-mail: deblevin@umich.edu.

Abstract: Background:Older adults with mild cognitive impairment (MCI) receive fewer guideline-concordant treatments for multiple health conditions than those with normal cognition. Reasons for this disparity are unclear. Objective:To better understand this disparity, we describe physician understanding and experience with patient MCI, particularly physician identification of MCI, ability to distinguish between MCI and dementia, and perspectives on education and training in MCI and dementia. Methods:As part of a mixed-methods study assessing the influence of patient MCI on physician recommendations for acute myocardial infraction and stroke treatments, we conducted a descriptive qualitative study using semi-structured interviews of physicians from three specialties. Key question topics included participants’ identification of MCI, impressions of MCI and dementia awareness within their practice specialty, and perspectives on training and education in MCI. Results:The study included 22 physicians (8 cardiologists, 7 neurologists, and 7 internists). We identified two primary themes: There is 1) a lack of adequate understanding of the distinction between MCI and dementia; and 2) variation in physician approaches to identifying whether an older adult has MCI. Conclusion:These findings suggest that physicians have a poor understanding of MCI. Our results suggest that interventions that improve physician knowledge of MCI are needed.

Keywords: Cognition, dementia, diagnosis, physician knowledge

DOI: 10.3233/JAD-210565

Journal: Journal of Alzheimer's Disease, vol. 85, no. 1, pp. 273-282, 2022