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Clinical Atlas Prestige · Evidence-first

Psych VivasConsultation-liaison psychiatry

Psych Vivas · Consultation-liaison psychiatry

Mild cognitive impairment — structured clinical viva

Fellowship viva on MCI/mild NCD nosology, assessment, conversion, lifestyle care, and AChEI evidence limits.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar in a memory clinic. A 69-year-old woman reports two years of progressive forgetfulness. She still lives alone, manages medications with a dosette box, shops online, and drives short daytime trips. Her son worries she is 'getting dementia'. MoCA is 24/30. She is on amitriptyline 50 mg nocte for sleep and has untreated hearing loss. Discuss definition and subtypes, differentials including depression and major NCD, assessment tools, conversion risk, management including lifestyle evidence, and why cholinesterase inhibitors are not routine.

Interpretation

Reveal interpretation

Nosology. History and MoCA support clinical MCI / mild NCD if independence is truly preserved with compensation (dosette, limited driving). Not major NCD unless IADL independence is lost. Subtype likely amnestic pending domain mapping; specify single- vs multi-domain after detailed testing.[1][2]

Differentials. Depression; anticholinergic burden (amitriptyline); untreated hearing loss (Lancet modifiable risk); early major NCD under-reported by patient; delirium if any acute illness (not suggested here).[10]

Assessment. Collateral, MSE, MoCA (more sensitive than MMSE for mild deficits), functional interview, bloods, imaging once, mood and sleep, deprescribe amitriptyline if safe, hearing assessment. Capacity decision-specific (Appelbaum) — living alone does not equal incapacity.[8][9][3]

Conversion. Elevated risk; clinic order-of-magnitude ~5–10%/year historically cited; reversion and stability occur (Mitchell). Avoid fatalism and false certainty.[6]

Management. Lifestyle/risk-factor focus (Lancet; FINGER multidomain). No routine AChEI: Petersen 2005 (donepezil not durable; Vit E negative), Cochrane Russ, AAN 2018. Driving case-by-case. Follow-up serial review.[3][4][5][7][10]

Structured viva prompts

Definition and classification

Q. Define MCI and mild NCD; how do they relate? A. Clinical MCI (Petersen): concern, objective impairment, preserved function, not demented. Mild NCD (DSM): modest multi- or single-domain decline without loss of independence. Overlapping constructs; independence is the hinge vs major NCD.[1][2]

Conversion

Q. What do you tell families about risk? A. Higher than peers; annual clinic rates often ~5–10% order of magnitude; many do not convert soon; some improve. Multi-domain and biomarker-positive profiles higher risk.[6]

Pharmacology trap

Q. She wants donepezil today. Your answer? A. Not routine for MCI. Cite Petersen 2005, InDDEx/Cochrane/AAN: no reliable long-term conversion prevention; adverse effects. Offer lifestyle plan and review.[3][4][5]

Prevention evidence

Q. Name non-drug evidence. A. Lancet Commission modifiable risks; FINGER multidomain RCT signal in at-risk elderly.[7][10]

References

  1. [1]Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome Arch Neurol, 1999.PMID 10190820
  2. [2]Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment J Intern Med, 2004.PMID 15324367
  3. [3]Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update summary: Mild cognitive impairment [RETIRED]: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology Neurology, 2018.PMID 29282327
  4. [4]Petersen RC, Thomas RG, Grundman M, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment N Engl J Med, 2005.PMID 15829527
  5. [5]Russ TC, Morling JR Cholinesterase inhibitors for mild cognitive impairment Cochrane Database Syst Rev, 2012.PMID 22972133
  6. [6]Mitchell AJ, Shiri-Feshki M Rate of progression of mild cognitive impairment to dementia--meta-analysis of 41 robust inception cohort studies Acta Psychiatr Scand, 2009.PMID 19236314
  7. [7]Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial Lancet, 2015.PMID 25771249
  8. [8]Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment J Am Geriatr Soc, 2005.PMID 15817019
  9. [9]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment N Engl J Med, 1988.PMID 3200278
  10. [10]Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission Lancet, 2020.PMID 32738937