High Interest in Screening and Treatment for Mild CognitiveImpairment in Older Adults: A Pilot Study

William Dale, MD, PhD, Gavin W. Hougham, PhD,w Emily Kay Hill, BA,z and Greg A. Sachs, MD

(See editorial comments by Dr. A. Mark Clarfield on pp 14651466)

OBJECTIVES: To assess interest of older adults in screen-ing and treatment for mild cognitive impairment (MCI).

DESIGN: Cross-sectional, in-person pilot survey with aconvenience sample.

SETTING: Two university-based geriatrics clinic waitingrooms in Chicago.

PARTICIPANTS: Healthy adults aged 35 and older with-out cognitive impairment (n5149).

MEASUREMENTS: Following a description of MCI ex-tracted from the Alzheimers Association Website FactSheet, questions concerning willingness to be screened andtreated for MCI.

RESULTS: Ninety-eight percent of respondents would bewilling to be tested for MCI if a family member suggestedthey had memory problems, 99% were willing to take amedication if it would cut the risk of conversion from MCIto Alzheimers disease (AD) in half, and 92% would takea medication to delay the conversion from MCI to AD by1 year. If a family member suggested memory problems,African Americans were more willing than whites to bescreened for MCI (75% vs 57%; P5.05).

CONCLUSION: Older adults expressed high interest inscreening and treatment for MCI. Interest in screening is evenstronger in African Americans than in whites. Such high in-terest is potentially troubling, given the current state of knowl-edge about MCI. J Am Geriatr Soc 54:13881394, 2006.

Key words: mild cognitive impairment; MCI; screening;treatment decisions

Mild cognitive impairment (MCI) is increasingly beingconsidered a clinical entity that is a precursor state

to Alzheimers disease (AD). The likelihood of being diag-nosed with AD increases from a baseline annual incidencerate of 1% to 2% for those not characterized with MCI to12% to 15% for people defined as having MCI.1 This con-version rate suggests that MCI is a precursor state to orperhaps a risk factor for the development of AD and thus aclinical entity that might be a target for screening, treat-ment, and prevention.2

As with any other diagnosis, to justify screening, MCImust meet certain evidence-based standards. It must becommon; it must have sensitive and specific tests availablefor its detection; it must have efficacious treatment availa-ble; if treatment exists, treated patients must have betteroutcomes than untreated patients; and the benefits fromscreening (and earlier treatment) must outweigh the harms.3

MCI does not currently meet these standards, because al-though it is reasonably common,4 the remaining criteria arestill being debated in the scientific literature.5 In fact,whether appropriate criteria have been met for screening forAD itself remains doubtful, much less for MCI, and leadingauthorities do not recommend general population screeningfor dementia.1,6 Nevertheless, there has been an increase inadvocacy for screening and treatment for AD and MCI de-spite ambiguous evidence of effectiveness. Recent studiespresent potential new screening and detection methods forMCI or early AD, including neuropsychological tests,79

telephone interviewing,10 olfactory testing,11 psychologicalor personality changes,12 neuroimaging,13 and biomarkeridentification.14 This has accompanied studies reportingefficacy in treatment with cholinesterase inhibitors.1517

Although anecdotal evidence suggests rising public in-terest in screening for dementia,18 nothing quantitative isknown about public interest in screening for MCI. A pilotstudy was therefore conducted with a convenience sampleof older adults in Chicago to assess their interest level inscreening for and treating MCI.

METHODS

Sample

Face-to-face interviews were conducted with a conveniencesample of 149 adults recruited from two university-based

Address correspondence to William Dale, MD, PhD, Assistant Professorof Medicine, Section of Geriatrics, University of Chicago,Department of Medicine, MC 6098, Chicago, IL 60637.E-mail: wdale@medicine.bsd.uchicago.edu

DOI: 10.1111/j.1532-5415.2006.00852.x

From the Section of Geriatrics, University of Chicago, Chicago, Illinois;wThe John A. Hartford Foundation, New York, New York; and zUniversity ofWisconsin, Madison, Wisconsin.

JAGS 54:13881394, 2006r 2006, Copyright the AuthorsJournal compilation r 2006, The American Geriatrics Society 0002-8614/06/$15.00

geriatrics outpatient clinic waiting rooms on Chicagossouth side. These clinics provide primary care and consult-ative geriatrics services. Two of the authors (WD, GS) areamong a group of 12 attending physicians who see patientsin these clinics. All physicians in these locations gave per-mission to have their patients and patients family membersinterviewed. Eligible participants included English-speak-ing patients attending the clinics and any adult aged 35 andolder accompanying patients. Recruitment occurred in thewaiting area of clinics and was independent of physicianspracticing at the time, including study authors. In addition,possible participants were excluded if they had a diagnosisof or reported taking medications for dementia or MCI. Thepatient population in these clinics was 74% African Amer-ican and 73% female, and almost all were aged 65 andolder. The remaining discrepancies between these valuesand the sample, primarily the inclusion of those youngerthan 65, reflect recruitment of participants other than pa-tients in the waiting areas. Research assistants reported thatapproximately 50% to 60% of those approached agreed toparticipate. (Given confidentiality and Health InsurancePortability and Accountability Act and institutional reviewboard concerns, it was not possible to obtain any additionalinformation about those who refused.) Upon obtaininginformed consent, interviews were conducted in a private,confidential area. The survey took an average of 24 min-

utes to complete. The University of Chicagos BiologicalSciences Division institutional review board approved theprotocol.

Questionnaire

The study questionnaire was designed to assess interest inbeing screened and treated for MCI. The content was de-veloped through local expert discussion and consensus ofparticipants with significant experience treating patientswith dementia and MCI. Domains assessed included, butwere not limited to, sociodemographics, self-assessed healthstatus, family history of dementia, attitudes toward AD,and current memory problems. The questionnaire under-went pilot testing for respondent burden and comprehen-sion, and necessary minor changes were made.19

Dependent Variables

Seven original questions regarding MCI screening andtreatment were the main dependent variables (Table 1).Four response categories were used: definitely yes, probablyyes, probably no, and definitely no. Anticipating that manyrespondents had not heard of MCI, and given the currentlack of professional consensus on a definition for MCI,study research assistants preceded these questions by read-ing a short paragraph defining and describing MCI, drawn

Table 1. Attitudes Toward Mild Cognitive Impairment (MCI) and Alzheimers Disease (AD) (N5 149)

Question Definitely Yes Probably Yes Definitely No Probably No

MCIHad you heard of the term mild cognitive impairment

before today?23 14 7 56

If you began to notice problems with your memory, wouldyou go see your doctor to see if you have mild cognitiveimpairment?

55 27 16 2

Would you be willing to be tested for mild cognitiveimpairment if a family member suggested that you werehaving memory problems?

73 25 1 1

Would you want your doctor to test your memory to see ifyou have mild cognitive impairment as part of the medicalexam even if you had not noticed any memory problems?

54 26 11 10

If you had mild cognitive impairment, would you be willing totake medications to help slow down memory loss?

67 25 6 2

Would you be willing to take medications to help slow downmemory loss?

74 25 1 1

Would you be willing to take a medication to treat mildcognitive impairment if it delayed the onset of Alzheimersdisease by 6 months?

61 19 15 5

Would you be willing to take a medication to treat mildcognitive impairment if it delayed the onset of Alzheimersdisease by 12 months?

69 23 6 2

ADDo you worry about developing Alzheimers disease? 15 26 17 41Do you feel you are more likely to develop Alzheimers

disease over your lifetime than most?6 13 39 41

Would you be surprised if you developed Alzheimersdisease in your lifetime?

35 21 27 16

Would you want to know as early as possible that you hadAlzheimers disease?

82 10 5 4

HIGH INTEREST IN SCREENING AND TREATMENT FOR MCI 1389JAGS SEPTEMBER 2006VOL. 54, NO. 9

from the Alzheimers Association Website Fact Sheet onMCI on July 1, 2004:20

MCI is a general term most commonly used to describea subtle but measurable memory disorder. According to thisdefinition, a person with MCI has memory problems greaterthan normal for his or her age but does not show othersymptoms of dementia, such as impaired judgment or rea-soning. Scientists are still working to understand MCI and itsrelationship to Alzheimers disease. Other details about MCIalso remain unclear. For example, some research suggeststhat nearly all cases of MCI progress eventually to Alz-heimers disease or another form of dementia. This wouldmean that MCI is actually a very early stage of dementia.Other studies suggest that some people with MCI may notdevelop dementia and some may even revert to normal butthat many are at high risk of progressing to dementia.

(The Fact Sheet was altered in April 2005, so there arenow some minor differences between the wording in thisstudy and the current version at the site.)

Analyses

Descriptive statistics were calculated and reported as fre-quencies. Given the overall high levels of interest in screen-ing and treatment for MCI and relatively modest cell countsin the other categories, for statistical comparison betweengroups, responses were dichotomized into those respondingdefinitely yes and all others (probably yes, probably no, anddefinitely no). Groups were compared using chi-square testsor Fischers exact test for dichotomized responses, as ap-propriate. All analyses were completed with SPSS 13.0(SPSS Inc., Chicago, IL).

RESULTS

Sociodemographics

Enrolled participants were fairly typical for these clinics onthe south side of Chicago: primarily older African-Amer-ican women and relatively highly educated and healthy(Table 2).

Attitudes Toward MCI and AD

An overwhelming majority of participants expressed inter-est in being screened and receiving treatment for MCI. Eventhough only 23% had definitely heard of MCI, 98% wouldhave been willing to be tested if a family member suggestedthat they were having memory problems, 80% would wanttesting for MCI as a routine part of a medical examination,and 83% would be willing to see their doctor about MCIfor self-identified memory problems. Ninety-nine percentwere willing to take medication to cut the risk of conversionfrom MCI to AD in half, 92% would take medication todelay the conversion by 1 year, and 80% would take med-ication to delay the conversion by 6 months (Table 1).

Many participants reported knowing someone withAD, including those with a relative with AD (46%) andthose taking care of someone with AD (40%). More than40% believed themselves to have memory problems,15% believed they had always had memory problems, andonly 15% reported having had any sort of memory test-ing. More than 80% definitely wanted to know earlyabout having AD, approximately 60% would have been

surprised to receive the diagnosis of AD, and 41% worryabout getting AD.

Relationship Between Screening and Treatment Attitudesand Sociodemographic Characteristics and AttitudesToward AD

The relationship between sociodemographic characteristicsand willingness to be screened and treated for MCI differedby ethnicity, marital status, and desire to be diagnosed earlywith AD. African Americans more often answered definitelyyes with respect to being screened for MCI; this differencereached statistical significance for wanting a MCI test as aregular part of a medical examination (65% vs 35%; P5.05)and for willingness to be tested for MCI at a family memberssuggestion (75% vs 57%; P5.05). Those who were married

Table 2. Sociodemographic and Health Characteristics(N5149)

Characteristic %

Ageo65 2965 71

SexMale 71Female 29

Marital statusMarried/partner 46Unmarried/no partner 54

EthnicityAfrican American 65White 28Other 7

Education8th grade 5Some high school 3High school graduate 19Some college 39College graduate 16Advanced degree 19

Health statusExcellent 14Very good 31Good 36Fair/poor 19

Cancer screeningMammogram (women only) 83Pap smear (women only) 64Prostate-specific antigen (men only) 72Colon cancer screen 72

Experience with AD and memory impairmentKnown someone with AD 87Has relative with AD 46Taken care of someone with AD 40Think you currently have memory problems 42Think youve always had memory problems 15Had previous memory testing 15

Includes American Indian/Alaskan Native (n53), Hispanic (n5 2), andmore than one (n55).AD5Alzheimers disease.

1390 DALE ET AL. SEPTEMBER 2006VOL. 54, NO. 9 JAGS

were more willing to be treated for MCI across all measures,although the difference was statistically significant only forbeing willing to take medication to cut the conversion rate toAD in half (83% vs 68%; P5.05) (Table 3).

Those saying that they would want to know early ifthey had AD were significantly more willing to be testedand treated for MCI across the board. A number of atti-tudes were associated with willingness to be tested for MCIif a family member suggested it. Those who had previouslyheard of MCI were much less willing to be tested (38% vs63%; P5.05). Conversely, those who believed that they

were more likely than average to develop AD and those whohad relatives with AD were much more willing to be testedif a family member suggested testing.

DISCUSSION

These findings convey a clear message; older adults sur-veyed in two clinics in Chicago reported a strong interest inbeing screened and treated for MCI. This interest in screen-ing was strongest in African Americans and those whowanted to know early about a diagnosis of AD.

Table 3. Attitudes Toward Screening and Treatment for Mild Cognitive Impairment (MCI) by Sociodemographic Char-acteristics and Attitudes Toward Cognitive Impairment: Percentage Saying Definitely Yes (N5149)

Characteristic

Screening Treatment

See DoctorIf NoticedMemory

Problems

Want MCITest as Partof Physical

Examination

Willing toTest for

MCI If FamilySuggests

Willing to TakeMedication toSlow Memory

Loss

Willing to TakeMedication toCut AD Risk in

Half

Willing to TakeMedication toDelay AD 1

Year

Willing to TakeMedication toDelay AD 6

Months

%

Ageo65 57 72 48 62 74 64 5265 54 73 56 70 74 71 65

SexMale 55 53 74 65 72 69 61Female 55 55 68 73 78 68 63

Marital statusMarried/partner 56 53 72 72 83 73 64Unmarried/no partner 53 53 72 65 68 65 58

Ethnicity

African American 54 60w 75w 70 72 67 60White 46 33w 57w 67 77 67 56

EducationHigh school graduate 54 62 81 68 70 54 68Some college 52 58 67 65 70 65 61College graduate 73 46 73 77 82 77 73Advanced degree 46 39 68 62 77 69 58

Health statusExcellent/very good 52 56 72 60 73 54 67Good/fair/poor 56 51 73 73 74 66 70

Heard of MCIYes 55 71 38w 70 79 68 60No 55 74 63w 66 70 69 62

Believed they were more likely to develop AD than averageYes 57 71 71w 68 68 61 57No 54 73 50w 67 75 70 62

Would want to know early if they had ADYes 58w 76w 57w 70w 73 72w 64w

No 25w 36w 17w 33w 75 33w 33w

Would be surprised if they developed ADYes 59 77 54 69 73 79w 68w

No 50 67 53 65 74 55w 52w

Worried about developing ADYes 58 72 50 65 72 63 58No 53 73 57 69 75 72 63

Excludes American Indian/Alaskan Native (n53), Hispanic (n5 2), and more than one (n5 5).wPo.05.AD5Alzheimers disease.

HIGH INTEREST IN SCREENING AND TREATMENT FOR MCI 1391JAGS SEPTEMBER 2006VOL. 54, NO. 9

This willingness was especially impressive given thatmost respondents had never heard of MCI before, manyhad significant experience with AD, and a majority worriedabout developing AD, each of which might have been ex-pected to make people fearful of a diagnosis of MCI. The60% of people who had not heard of MCI before this sur-vey were more willing to be tested for it. One attitude madepeople more desirous of screening and treatment for MCI:wanting to know early if one had AD. This highlights apotentially vulnerable population: those who are especiallywilling to undergo testing and treatment that has not yetbeen convincingly shown to be clinically beneficial.

This enthusiasm is unwarranted given the paucity ofevidence supporting screening for dementia and MCI.6

Some researchers argue that it is reasonable to pursue earlydetection for dementia in those desiring testing.1 There arelarge numbers of unrecognized, cognitively impaired olderadults, which has led some to advocate greater community-wide screening for dementia.21 Although the evidence sup-porting the combined use of cholinesterase inhibitors andmulticomponent interventions to treat early AD to delaynursing home placement may justify identification of thosewith early AD, it does not currently justify populationscreening for early AD.6 Although two recent studies haveshown measurable benefits from treatment of MCI withdonepezil,16,17 the clinical benefits appear limited in effectand short-lived in duration. The largest study shows statis-tically significant delay in progression from MCI to AD at12 months but no difference in progression between groupsafter 3 years.17 Despite this limited and transient benefit,the results were interpreted and publicized as a success indelaying conversion of MCI to AD.22 Respondents in thecurrent study showed less interest in treatment for MCIwhen the delay to progression from MCI to AD was low-ered from 12 to 6 months (92% vs 80%; Po.001). Nev-ertheless, interest in treatment for MCI remains high evenfor these modest gains. Another concern with use of cholin-esterase inhibitors is adverse events, including diarrhea,nausea, vomiting, muscle cramps, and abnormal dreamsFside effect rates that are higher for MCI than AD patients.17

Also, in the galantamine MCI clinical trials, there was amanufacturer-issued warning about an unexpectedly highernumber of deaths in the treatment group than in controls.23

No medications are currently approved by the Food andDrug Administration (FDA) for the treatment of MCI. Giv-en all of this, community-wide screening for a disease withmarginally effective therapies seems unwarranted.

There are additional social, psychological, and ethicalconcerns when considering MCI screening and treatment.One concern is the development and aggressive marketingof over-the-counter commercial products for memory test-ing whose efficacy is questionable.18 Another concern is thepotential labeling effect of the diagnosis of MCI. Peoplewho, by definition, have no functional impairments couldexperience negative social and psychological consequencesfrom being told they have a condition with serious conse-quences and only marginally effective therapies available.24

Such labeling is especially troubling given the unsettledprognosis associated with the imprecisely defined diagnosisof MCI, with evidence that a higher percentage of peoplewith cognitive impairmentFno dementia (CIND) return tonormal (25%) annually than convert to AD (10%).25

There is reason to wonder whether this expressed in-terest will translate into an actual increase in screening ortreatment rates. It has been shown that, in contrast to thefindings of the current study, only about half of those incontinuous care retirement communities would agree toroutine screening for memory problems.26 Furthermore, arecent study examining the feasibility of a community-based program for dementia screening showed a nearly50% drop-off between those who screened positive andthose who followed up for further confirmatory testing.27

Although about half of the sample in the current studythought that they had memory problems or were unsureabout having memory problems, only 15% had ever beentested for such problems, again suggesting that expressedinterest may not lead to action. However, even if only halfof the patients who indicated an interest in screening forMCI followed through, that is still approximately 35% to45% interest in screening for an ambiguous disease entitywith no FDA-approved treatments.

There remain limitations to this study. One, the sampleof respondents was from two clinics on the south side ofChicago and may not generalize to other populations. Forthis reason, the study should be considered preliminary andshould be repeated in larger, more representative samples.However, the high proportion of African-American re-spondents is unusual, and their inclusion should be con-sidered a strength of the study. Two, it might be thoughtthat the paragraph used to describe MCI to respondentswas overly alarming, inducing respondents to express a de-sire for screening that they would not express had theyknown more fully the relevant research findings. To mostthe description fairly, impartially, and accurately repre-sented current understanding of MCI for a public audiencefrom a readily available source, i.e., the description wasadapted from the Alzheimers Association Fact Sheet onMCI.20 As an educational and advocacy organizationwhose mission includes raising public awareness and rais-ing money to support AD research, it might be said that thisorganization is biased toward seeing MCI as prodromalAD. Still, if the respondents are overreacting to this de-scription, this reaction highlights concern about peoplesresponse to the information available about MCI from rep-utable sources like the Alzheimers Association, and it sug-gests even greater concern about the publics potentialsusceptibility to the promotional practices of potentiallymore biased sources such as drug manufacturers. In addi-tion, those who had heard of MCI before taking the surveywere much less willing to be tested at a family memberssuggestion. This may suggest that these people had more, orat least different, information about MCI and that this al-ternative knowledge decreases the willingness to be tested.This intriguing finding also warrants further exploration.Three, the finding that African Americans are more inter-ested in screening than whites contrasts with other worksuggesting that they are less likely to engage in preventiveinterventions or enroll in clinical trials,28 and AfricanAmericans are known to be underrepresented in dementiaresearch.29 It is not known why the opposite is the case inthe sample in the current study, but it is a finding worthy offurther exploration. One potential explanation concernsthe reading level of the explanatory paragraph and patienteducation levels as a proxy for health literacy. On the

1392 DALE ET AL. SEPTEMBER 2006VOL. 54, NO. 9 JAGS

Flesch-Kincaid Grade Level score, the extracted paragraphreads at a 12th-grade level, or a high school graduate. Inaddition, a significantly higher percentage of the AfricanAmericans than of the whites in the sample had a highschool education or less (35% vs 10%; P5.003). Althoughthere is no direct evidence, it is possible that lower healthliteracy among the African Americans in the sample ac-counts for the increased interest in screening. Four, concernscould be raised that two of the authors (WD, GS) werephysicians for patients (and families) that attended the clin-ic and who were enrolled in the study. The presumed di-rection of bias is that patients with an establishedrelationship with the physicianauthors would be more in-clined to want screening and treatment in an effort to pleasethe physicians. However, it is likely that the opposite is trueof the doctors known practice patterns, because they havemisgivings about unwarranted screening and treatmentand, if anything, have encouraged their patients to be cau-tious with such pursuits. Additionally, they are both pri-marily researchers, so their clinical load of 2 half-days perweek each are the lowest in the group of 11 physicians andfour advanced-practice nurses. The recruitment of patientsby research assistants was independent of those in the clinic,so the clinicians knew almost nothing about which patientsand family members had been recruited. GS sees patientsthrough the Memory Center, and the vast majority of hispatients have cognitive impairment, which was an exclu-sion criterion for the study. Five, information on the costsand medication side-effect profiles of screening or treatingMCI were not included, because patients are rarely toldabout such costs when asked whether they are interested inscreening for a disease; for example, the Alzheimers Asso-ciation Website from which the text describing MCI wastaken does not include a discussion of costs. Six, the par-ticipants were not asked to take action and follow up ontheir stated intentions to be screened for MCI, and perhapsthis stated enthusiasm will not translate into further action.

CONCLUSION

These findings should be viewed as an early, cautionary taleabout the latent interest in screening in a target group fora disease entity not yet fully characterized; with uncertainprognosis; with limited treatment options; having signifi-cant side effects; and with underappreciated social, psy-chological, and ethical consequences. This study, ifconfirmed in larger, more-representative samples, suggeststhat a large amount of interest in screening and treatmentfor MCI exists in many otherwise healthy older adults.Along with others,30 the authors recommend caution inpromoting early detection and treatment for MCI, espe-cially in light of the high interest shown by the respondents.A much stronger evidence base supporting screening andtreating MCI is needed before it is actively promoted topatients.

ACKNOWLEDGMENTS

The authors would like to thank the following individuals forcommenting on earlier versions of the manuscript: CarolStocking, PhD; Joseph Shega, MD; Sadhna Diwan, PhD; andtwo anonymous reviewers. They would also like to thank thefollowing for assistance with data acquisition and manage-

ment: Joshua Hemmerich, PhD, Jessica Wilson, BA, andJennifer Skrzypczynski.

Financial Disclosure: William Dale: The John A. Hart-ford Center of Excellence in Geriatric Medicine Pilot Grant#20030201, 27239; National Institutes of Health/NationalInstitute on Aging (NIA) Paul B. Beeson Career DevelopmentAwards in Aging, 1 K23 AG 02481201. Gavin W. Hough-am is now Senior Program Officer at The John A. HartfordFoundation, the same organization from which Dr. Dale re-ceived his pilot grant, but Dr. Hougham worked for theUniversity of Chicago at the time the grant was awarded toDr. Dale, and his role as Senior Program Officer was unre-lated in any way to determination of the grant award.Throughout, Dr. Dale has had complete editorial controlover the data and content of this manuscript. Emily K. Hill:Summer Training on Aging Research TopicsFMentalHealth Program (START-MH), 2004. Greg A. Sachs: Mul-tiple funding sources from NIA, Agency for Healthcare Re-search and Quality, The John A. Hartford Foundation, andthe Donald W. Reynolds Foundation, none of which repre-sent a conflict of interest related to this study.

Author Contributions: William Dale: lead role in studyconcept and design, acquisition of data, analysis and inter-pretation of data, and manuscript preparation. Gavin W.Hougham: co-lead role in study concept and design, dataanalysis, and manuscript preparation. Emily K. Hill: co-lead role in survey design and pilot testing of instrument,and helped with manuscript preparation. Greg A. Sachs: co-lead role in study concept and design, interpretationof the data, preparation of the manuscript, and fundingsupport.

Sponsors Role: No sponsornot a clinical trial.

REFERENCES

1. Petersen RC, Stevens JC, Manguli M et al. Practice parameter: Early detection

of dementia: Mild cognitive impairment (an evidence-based review). Neurol-

ogy 2001;56:11331142.

2. Petersen RC, Morris JC. Mild cognitive impairment as a clinical entity and

treatment target. Arch Neurol 2005;62:11601163.

3. Barratt A, Irwig L, Glasziou P et al. How to use guidelines and recommen-

dations about screening. JAMA 1999;281:20292034.

4. Yasavage JA, Ohara R, Kraemer H et al. Modeling the prevalence and in-

cidence of Alzheimers disease and mild cognitive impairment. J Psych Res

2002;36:281286.

5. Whitehouse PJ, Juengst ET. Antiaging medicine and mild cognitive impair-

ment. Practice and policy issues for geriatrics. J Am Geriatr Soc

2005;53:14171422.

6. Boustani M, Peterson B, Hanson L et al. Screening for dementia in primary

care: A summary of the evidence for the U.S. Preventive Services Task Force.

Ann Intern Med 2003;138:927937.

7. Galluzzi S, Cimaschi L, Ferrucci L et al. Mild cognitive impairment: Clinical

features and review of screening instruments. Aging Clin Exp Res

2001;13:183202.

8. Xu G, Meyer JS, Thornby J et al. Screening for mild cognitive impairment

(MCI) utilizing combined mini-mental-cognitive capacity examinations for

identifying dementia prodromes. Int J Geriatr Psychiatry 2002;17:10271033.

9. Artero S, Ritchie K. The detection of mild cognitive impairment in the general

practice setting. Aging Ment Health 2003;7:251258.

10. Lines CR, McCarroll KA, Lipton RB et al. Telephone screening for amnestic

mild cognitive impairment. Neurology 2003;60:261266.

11. Wang Q-S, Tian L, Juang Y-L et al. Olfactory identification and apolipoprotein

E e4 allele in mild cognitive impairment. Brain Res 2002;951:7781.

12. Balsis S, Carpenter BD, Storandt M. Personality change precedes clinical di-

agnosis of dementia of the Alzheimer Type. J Gerontol B Psychol Sci Soc Sci

2005;60B:P98P101.

13. Chetelat G, Baron J-C. Early diagnosis of Alzheimers disease: Contribution of

structural neuroimaging. Neuroimage 2003;18:525541.

HIGH INTEREST IN SCREENING AND TREATMENT FOR MCI 1393JAGS SEPTEMBER 2006VOL. 54, NO. 9

14. Georganopoulou DG, Chang L, Nam J-M et al. Nanoparticle-based detection

in cerebral spinal fluid of a soluble pathogenic biomarker for Alzheimers

disease. Proc Natl Acad Sci USA 2005;102:22732276.

15. Group AC. Long-term donepezil treatment in 565 patients with Alzheimers dis-

ease (AD 2000): Randomised double-blind trial. Lancet 2004;363:21052115.

16. Salloway S, Ferris S, Kluger A et al. Efficacy of donepezil in mild cognitive

impaiarment: A randomized placebo-controlled trial. Neurology 2004;63:

651657.

17. Petersen RC, Thomas RG, Grundman M et al. Vitamin E and donepezil for the

treatment of mild cognitive impairment. N Engl J Med 2005;352:23792388.

18. Kier FJ, Molinari V. Do-it-yourself dementia testing: Issues regarding an

Alzheimers home screening test. Gerontologist 2003;3:295301.

19. Hill EK, Dale W, Hougham GW et al. Factors Predicting Intention to Be

Screened for Mild Cognitive Impairment (MCI): Instrument Development.

Paper presented at: Summer Training on Aging Research Topics-Mental

Health (START-MH), San Diego, CA, August 2004.

20. Alzheimers Association. Fact Sheet: Mild Cognitive Impairment (MCI) [on-

line]. Available at http://www.alz.org/resources/topicindex/mci.asp Accessed

November 5, 2004.

21. Callahan CM, Hendrie HC, Tierney WM. Documentation and evaluation of

cognitive impairment in elderly primary care patients. Ann Intern Med 1995;

122:422429.

22. Grady D. Drug shows promise in slightly delaying the onset of Alzheimers.

New York Times July 19, 2004.

23. Saul S. Company news: Johnson & Johnson issues Alzheimers drug warning.

New York Times April 2, 2005.

24. Shaw C, Abrams K, Marteau TM. Psychological impact of predicting

individuals risks of illness: A systematic review. Soc Sci Med 1999;49:

15711598.

25. Unverzagt FW, Gao S, Baiyewu O et al. Prevalence of cognitive impairment:

Data from the Indianapolis Study of Health and Aging. Neurology 2001;

57:16551662.

26. Boustani M, Watson L, Fultz B et al. Acceptance of dementia screening in

continuous care retirement communities: A mailed survey. Int J Geriatr Psy-

chiatry 2003;18:780786.

27. Boustani M, Callahan CM, Unverszgt FW et al. Implementing a screening and

diagnosis program for dementia in primary care. J Gen Intern Med 2005;20:

572577.

28. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials.

Race, sex-, and age-based disparities. JAMA 2004;291:27202726.

29. Stephenson J. Racial barriers may hamper diagnosis, care of patients with

Alzheimer disease. JAMA 2001;286:779780.

30. Gauthier S, Touchon J. Mild cognitive impairment is not a clinical entity and

should not be treated. Arch Neurol 2005;62:11641166.

1394 DALE ET AL. SEPTEMBER 2006VOL. 54, NO. 9 JAGS