To explore practice patterns in managing minor cognitive impairment (MCI).

The investigation and management of MCI is considered important as it offers the opportunity to potentially stave off conversion to dementia.  However, there are few data on current practices/approaches in this area; such data can help identify potential disparities and anticipate adoption of new therapies.

We performed a worldwide electronic survey of neurology practitioners through the Practice Current section of Neurology: Clinical Practice with clinical and practice-related questions in 2021, and repeated it in 2024 following the FDA’s approval of anti-amyloid therapies. Clinical questions addressed access to and utilization of diagnostic investigations, pharmacological and non-pharmacological management of MCI, and (in 2024) attitudes towards novel anti-amyloid agents. Responses were compared using Fisher’s exact test and multivariable logistic regression adjusted for region, regional income, year of survey response, years in practice, and number of cognitive patients seen annually.

We received 1,257 responses from 95 countries, including 237 cognitive subspecialists and 464 respondents from low/middle income countries. On multivariate analysis, cognitive subspecialists were more likely to investigate MCI with a lumbar puncture (aOR 1.90, 95% CI 1.32-2.73), fluorodeoxyglucose positron emission tomography (FDG-PET, aOR 1.45, 95%CI 1.00-2.10), and to offer pharmacotherapy if investigations suggested neurodegeneration (aOR 1.92, 95%CI 1.29-2.85).  Regionally, respondents from Europe, Latin America, and Asia were more likely than those from USA/Canada to order FDG-PET (e.g. Europe: aOR 2.38, 95%CI 1.29-4.39) and amyloid PET (Europe: aOR 3.30, 95%CI 1.85-5.87), controlling for reported access to these tests. Pharmacological and non-pharmacological approaches were comparable between cognitive subspecialists and other respondents. Attitudes toward prescribing new anti-amyloid agents were similar among all respondents, reflecting a generally favourable attitude (e.g. 61.5% would prescribe anti-amyloid therapy if it was available).

Our results highlight practice differences among cognitive subspecialists and other practitioners worldwide in the management of MCI.