Kristian S Frederiksen1, Thomas R Nielsen1, Ildebrando Appollonio2, Birgitte Bo Andersen1, Mario Riverol3, Mercè Boada4,5, Mathieu Ceccaldi6, Bruno Dubois7, Sebastiaan Engelborghs8,9, Lutz Frölich10, Lucrezia Hausner10, Audrey Gabelle11, Tomasz Gabryelewicz12, Timo Grimmer13, Bernard Hanseeuw14, Jakub Hort15, Jacques Hugon16, Vesna Jelic17, Anne Koivisto18,19, Milica G Kramberger20, Thibaud Lebouvier21, Alberto Lleó22, Alexandre de Mendonça23, Flavio Nobili24,25, Pierre-Jean Ousset26, Robert Perneczky27,28,29,30, Marcel Olde Rikkert31, David Robinson32, Olivier Rouaud33, Elisabet Sánchez34, Isabel Santana35,36, Nikolaos Scarmeas37,38, Katerina Sheardova39, Stephanie Sloan40, Luiza Spiru41,42, Elka Stefanova43, Latchezar Traykov44, Görsev Yener45,46, Gunhild Waldemar1. 1. Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 2. School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy. 3. Department of Neurology, Clinica Universidad de Navarra, University of Navarra, Madrid, Spain. 4. Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain. 5. Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain. 6. Department of Neurology and Neuropsychology, CHU Timone, APHM and Aix Marseille University, Inserm, Institut de Neurosciences des Systèmes, Marseille, France. 7. Alzheimer Research Center (IM2A) and Department of Neurology, Salpêtrière University Hospital, AP-HP, Sorbonne University, Paris, France. 8. Reference Center of Biological Markers of Dementia (BIODEM), Institute Born-Bunge and University of Antwerp, Antwerp, Belgium. 9. Department of Neurology and Center for Neurosciences, UZ Brussel and Vrije Universiteit Brussel (VUB), Brussels, Belgium. 10. Department of Geriatric Psychiatry, Central Institute for Mental Health, University of Heidelberg, Mannheim, Germany. 11. Department of Neurology, Memory Resources and Research Center, Gui de Chauliac Hospital, Montpellier University Hospital, University of Montpellier, Montpellier, France. 12. Department of Neurodegenerative Disorders, Mossakowski Medical Research Centre PAN, Warsaw, Poland. 13. Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany. 14. Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Institute of Neuroscience, Brussels, Belgium. 15. Department of Neurology, Memory Clinic, Charles University, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic. 16. Center of Cognitive Neurology, Lariboisière Hospital Paris, University of Paris, Paris, France. 17. Clinic for Cognitive Disorders, Theme Aging, Karolinska University Hospital - Huddinge, Stockholm, Sweden. 18. Department of Neurology, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland. 19. Department of Neurosciences and Geriatrics, University of Helsinki, Helsinki University Hospital, Helsinki, Finland. 20. Center for Cognitive Impairments, University Medical Center Ljubljana, Ljubljana, Slovenia. 21. Lille 2 University of Health and Law, Pôle de Neurologie, Lille, France. 22. Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 23. Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal. 24. Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy. 25. IRCCS Ospedale Policlinico San Martino, Genova, Italy. 26. Memory Clinic, Clinical Research Center, Toulouse University Hospital, Toulouse, France. 27. Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany. 28. German Center for Neurodegenerative Disorders (DZNE) Munich, Munich, Germany. 29. Munich Cluster for Systems Neurology (SyNergy), Munich, Germany. 30. Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK. 31. Department of Geriatrics, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands. 32. Memory Clinic, St. James's Hospital, Dublin, Ireland. 33. Department of Clinical Neuroscience, Vaud University Hospital, Leenaards Memory Centre, Lausanne, Switzerland. 34. Servicio de geriatria, Hospital Universitario Ramon y Cajal, Madrid, Spain. 35. Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. 36. Faculty of Medicine, University of Coimbra, Coimbra, Portugal. 37. 1st Department of Neurology, Aiginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece. 38. Department of Neurology, Columbia University Medical Center, New York, USA. 39. Memory Center ICRC, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic. 40. Neuroprogressive Disorders and Dementia Network, Ninewells Hospital, Dundee, Scotland. 41. Geriatrics-Gerontology and Old Age Psychiatry (Alzheimer Unit) Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 42. Excellence Memory Clinic and Longevity Medicine, Ana Aslan International Foundation, Bucharest, Romania. 43. Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia. 44. Department of Neurology, UH "Alexandrovska", Sofia, Bulgaria. 45. Department of Neurosciences, Dokuz Eylül University Medical School, Izmir, Turkey. 46. Department of Neurology, Dokuz Eylül University Medical School, Izmir, Turkey.
Abstract
OBJECTIVES: Mild cognitive impairment (MCI) is associated with an increased risk of further cognitive decline, partly depending on demographics and biomarker status. The aim of the present study was to survey the clinical practices of physicians in terms of biomarker counseling, management, and follow-up in European expert centers diagnosing patients with MCI. METHODS: An online email survey was distributed to physicians affiliated with European Alzheimer's disease Consortium centers (Northern Europe: 10 centers; Eastern and Central Europe: 9 centers; and Southern Europe: 15 centers) with questions on attitudes toward biomarkers and biomarker counseling in MCI and dementia. This included postbiomarker counseling and the process of diagnostic disclosure of MCI, as well as treatment and follow-up in MCI. RESULTS: The response rate for the survey was 80.9% (34 of 42 centers) across 20 countries. A large majority of physicians had access to biomarkers and found them useful. Pre- and postbiomarker counseling varied across centers, as did practices for referral to support groups and advice on preventive strategies. Less than half reported discussing driving and advance care planning with patients with MCI. CONCLUSIONS: The variability in clinical practices across centers calls for better biomarker counseling and better training to improve communication skills. Future initiatives should address the importance of communicating preventive strategies and advance planning.
OBJECTIVES: Mild cognitive impairment (MCI) is associated with an increased risk of further cognitive decline, partly depending on demographics and biomarker status. The aim of the present study was to survey the clinical practices of physicians in terms of biomarker counseling, management, and follow-up in European expert centers diagnosing patients with MCI. METHODS: An online email survey was distributed to physicians affiliated with European Alzheimer's disease Consortium centers (Northern Europe: 10 centers; Eastern and Central Europe: 9 centers; and Southern Europe: 15 centers) with questions on attitudes toward biomarkers and biomarker counseling in MCI and dementia. This included postbiomarker counseling and the process of diagnostic disclosure of MCI, as well as treatment and follow-up in MCI. RESULTS: The response rate for the survey was 80.9% (34 of 42 centers) across 20 countries. A large majority of physicians had access to biomarkers and found them useful. Pre- and postbiomarker counseling varied across centers, as did practices for referral to support groups and advice on preventive strategies. Less than half reported discussing driving and advance care planning with patients with MCI. CONCLUSIONS: The variability in clinical practices across centers calls for better biomarker counseling and better training to improve communication skills. Future initiatives should address the importance of communicating preventive strategies and advance planning.