The MCI Sentinel Program™
Improving the Diagnostic Approach to MCI in the Primary Care Setting
Background
The MCI (Mild Cognitive Impairment) Sentinel Program™ was developed for primary care physicians to improve their diagnosis and management of MCI and early Alzheimer’s disease (AD). We felt that it was important to address the early identification of MCI in this setting because this may maximize the benefit of earlier intervention with medication and/or cognitive therapy (see Petersen et al. NEJM. 2005;352:2379-2388). Early and efficient identification of MCI also will result in more appropriate referrals to neurology specialists.
Because of the aging population, the expected increase in patients with AD means that the current number of neurologists in the US cannot easily and effectively care for these increasing numbers. The goal of The MCI Sentinel Program™ is to prepare a community of primary care physicians who will actively screen, diagnose, and promote early intervention and long-term clinical planning for patients with MCI.
The Activity
The program began with an initiative to understand the learning needs of primary care physicians in assessing and monitoring MCI in their older patients. Two sessions utilizing Nominal Group Technique among family practice and geriatric medicine physicians were followed by a brief survey about recognizing MCI administered to approximately 600 primary care practitioners.
The results of both the Nominal Group sessions and the survey were used to refine the educational objectives and content for a monograph entitled: The MCI Sentinel Program™: Improving the Diagnostic Approach to MCI in the Primary Care Setting.
The monograph was distributed in June 2007 to 5,000 physicians selected from states with large geriatric populations whose risk of MCI is elevated due to advanced age: California, Florida, New York, Pennsylvania, and Texas.
The monograph reviewed current data regarding the evaluation of MCI in the primary care setting, screening tools for MCI, and offered a sample of the Montreal Cognitive Assessment (MoCA). The MoCA appears to be the only screening test that has demonstrated a high enough sensitivity for MCI to be used reliably for diagnosis in this setting. Using a cutoff score of 26, the Mini Mental State Examination (MMSE), which is less specific, had a sensitivity of 18% to detect MCI. The sensitivity of the MoCA using the same cutoff score was 90%.