新版轻度认知障碍临床指南概要

美国神经病学学会(AAN)近期发布了新版轻度认知障碍(MCI)临床指南，指南专家组根据AAN的证据分类标准，系统回顾了MCI的发病率、预后和治疗方面的文献，并提出相关建议。文献分析结果显示，MCI的发病率随着年龄的增长而升高，MCI患者较同龄对照群体有着更高的痴呆转化风险。尚无高质量证据显示药物对治疗MCI有效，但锻炼可提升MCI患者的认知测验成绩，认知训练也有改善认知功能的可能性。指南建议临床医师应采用有效的工具评估MCI，主要评估MCI患者的各种风险因素、功能损伤，并对MCI患者的行为/神经精神症状进行评估和治疗，检测MCI患者的认知状况，终止可能造成认知损伤的药物治疗，还应建议患者定期锻炼身体，亦可进行认知训练。指南不建议临床医师为MCI患者提供胆碱酯酶抑制剂。

Summary of the latest practice guideline on mild cognitive impairment

The 2017 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI) has been published recently. The guideline panel systematically reviewed literatures on MCI prevalence, prognosis, and treatment according to AAN evidence classification criteria and provided recommendations based on the evidences. MCI prevalence increases with age. Individuals with MCI are at higher risk of progressing to dementia than age-matched controls. No high-quality evidence exists to support pharmacologic treatments effective for MCI. For patients with MCI, exercise training probably improve cognitive measures and cognitive training possibly improve cognitive ability. It is recommended that clinicians should assess MCI with validated tools, evaluate patients with MCI for modifiable risk factors and functional impairment, assess and treat behavioral/neuropsychiatric symptoms. Clinicians should monitor cognitive status of patients with MCI over time. Cognitively impairing medications should be discontinued. Clinicians should recommend regular exercise and cognitive training for patients. The guideline does not recommend that clinicians provide cholinesterase inhibitors for MCI patients.