New AAN Guideline: Exercise Has Cognitive Benefits in MCI

Megan Brooks

December 28, 2017

For patients with mild cognitive impairment (MCI), regular exercise is likely to improve cognitive functioning, an updated guideline from the American Academy of Neurology (AAN) concludes.

"It's exciting that exercise may help improve memory at this stage, as it's something most people can do, and of course it has overall health benefits," lead author Ronald C Petersen, MD, PhD, from the Mayo Clinic in Rochester, Minnesota, said in a statement.

The new guideline says cognitive training may improve cognitive measures, but there is no high-quality evidence to support pharmacologic treatments to ease symptoms of MCI.

The new AAN guideline on MCI, which is endorsed by the Alzheimer's Association, was published online December 27 in Neurology. It updates to the AAN's 2001 guideline on MCI.

To update the MCI guideline, Dr Peterson and the guideline panel systematically reviewed the latest published articles on MCI prevalence, prognosis, and treatment.

The data show that MCI prevalence increases with age, at 6.7% for ages 60 to 64 years, 8.4% for ages 65 to 69 years, 10.1% for ages 70 to 74 years, 14.8% for ages 75 to 79 years, and 25.2% for ages 80 to 84 years. The data also suggest that the incidence for the development of dementia is 14.9% in individuals with MCI older than age 65 years followed for 2 years.

The guideline recommends that patients with MCI exercise regularly as part of an overall approach to managing their symptoms. Although long-term studies have not been conducted, studies lasting 6 months suggest twice-weekly exercise training may improve memory.

There are currently no medications approved by the US Food and Drug Administration for the treatment of MCI, and there are currently no high-quality, long-term studies that suggest drugs or dietary changes can improve cognitive functioning in patients with MCI, the guideline says.

As for cognitive training, there is "insufficient" evidence to support or refute the use of any individual cognitive intervention strategy for MCI, the guideline says. There is "weak evidence" that cognitive training may be beneficial in improving measures of cognitive function, and physicians may recommend cognitive training for patients with MCI, the AAN says in a news release.

The updated MCI guideline also advises clinicians to:

  • assess for MCI using validated tools in appropriate scenarios (level B);

  • evaluate patients with MCI for modifiable risk factors, assess for functional impairment, and assess for and treat behavioral/neuropsychiatric symptoms (level B);

  • monitor cognitive status of patients with MCI over time (level B);

  • stop cognitively impairing medications where possible, and treat behavioral symptoms (level B);

  • consider not offering cholinesterase inhibitors (level B), and if offering, first discuss lack of evidence (level A);

  • recommend regular exercise (level B);

  • consider recommending cognitive training (level C);

  • discuss diagnosis, prognosis, long-term planning, and the lack of effective drug options (level B); and

  • consider discussing biomarker research with patients with MCI and families (level C).

Development of the guideline was funded by the American Academy of Neurology. Full disclosures for the guideline panel are listed with the original article.

Neurology. Published online December 27, 2017. Abstract

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