Communication and understanding of mild cognitive impairment diagnoses

Abstract

Background: Communication of mild cognitive impairment (MCI) diagnoses is challenging due to its heterogeneity and unclear prognosis.

Aim: To identify how MCI is communicated and to explore the relationship with patient and companion understanding.

Method: Conversation analysis identified whether MCI was named and explained in 43 video recorded diagnosis feedback meetings. Afterward, patients and companions were asked to name the diagnosis to assess understanding.

Results: Mild cognitive impairment was not named in 21% meetings. Symptoms were explained as (a) a result of vascular conditions (49%), (b) a stage between normal ageing and dementia (30%), or (c) caused by psychological factors (21%). Fifty-four percentage of prognosis discussions included mention of dementia. There was no association between symptom explanations and whether prognosis discussions included dementia. Fifty-seven percentage patients and 37% companions reported not having or not knowing their diagnosis after the meeting. They were more likely to report MCI when prognosis discussions included dementia.

Conclusions: Doctors offer three different explanations of MCI to patients. The increased risk of dementia was not discussed in half the diagnostic feedback meetings. This is likely to reflect the heterogeneity in the definition, cause and likely prognosis of MCI presentations. Clearer and more consistent communication, particularly about the increased risk of dementia, may increase patient understanding and enable lifestyle changes to prevent some people progressing to dementia.

Keywords: communication; diagnosis; mild cognitive impairment; prognosis; understanding; vascular cognitive impairment.