Background: Assessment of mild cognitive impairment (PD-MCI)

Cognitive decline is a common and disabling symptom of Parkinson’s. It is vital that clinicians have clear guidance on its assessment. However, the Evidence-Based Practice (EBP) Thematic Working Group identified a lack of consensus across current guidelines about who should be assessed for cognitive symptoms, when, and how. The group felt that assessment was particularly challenging when there is a clinical suspicion of PD-MCI. To address these challenges, the group developed a convenient, quick-reference clinical algorithm.

The algorithm promotes shared, individually tailored decisions, based on thoughtful integration of best available evidence, clinical expertise, and an appreciation of how proactive the person with Parkinson’s wishes their cognitive assessment to be.

Personal preference is particularly important in this context, because there are pros and cons to early diagnosis. On the ‘pro’ side of the equation, a diagnosis of cognitive impairment allows more informed life-planning, enhanced surveillance of cognitive symptoms, recognition of the need for strategies to preserve function and avoidance of medications that impair cognition. On the ‘cons’ side, a diagnosis of cognitive impairment cannot yet be accompanied by an offer of curative treatment. Nor can we offer an accurate prediction of how mild symptoms may/may not progress over time. Faced with these issues, some individuals may wish to seek the earliest possible diagnosis, and others may prefer a more conservative ‘watch and wait’ approach.

The clinical algorithm also assesses whether cognitive symptoms impact performance of so-called ‘instrumental activities of daily living’ - for example, managing personal finances, handling mail or using public transport. This provides a more meaningful assessment, with measures that can be monitored over time.