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Mild Cognitive Impairment: The Manchester consensus

Dunne, Ross A.; Aarsland, Dag; O'Brien, John T.; Ballard, Clive; Banerjee, Sube; Fox, Nick C.; Isaacs, Jeremy D.; Underwood, Benjamin R.; Perry, Richard J.; Chan, Dennis; Dening, Tom; Thomas, Alan J.; Schryer, Jeffrey; Jones, Anne Marie; Evans, Alison R.; Alessi, Charles; Coulthard, Elizabeth J.; Pickett, James; Elton, Peter; Jones, Roy W.; Mitchell, Susan; Hooper, Nigel; Kalafatis, Chris; Rasmussen, Jill G.C.; Martin, Helen; Schott, Jonathan M.; Burns, Alistair

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Ross A. Dunne

Dag Aarsland

John T. O'Brien

Clive Ballard

Sube Banerjee

Nick C. Fox

Jeremy D. Isaacs

Benjamin R. Underwood

Richard J. Perry

Dennis Chan

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Clinical Professor in Dementia Research

Alan J. Thomas

Jeffrey Schryer

Anne Marie Jones

Alison R. Evans

Charles Alessi

Elizabeth J. Coulthard

James Pickett

Peter Elton

Roy W. Jones

Susan Mitchell

Nigel Hooper

Chris Kalafatis

Jill G.C. Rasmussen

Helen Martin

Jonathan M. Schott

Alistair Burns


Given considerable variation in diagnostic and therapeutic practice, there is a need for national guidance on the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology in Mild Cognitive Impairment (MCI). MCI is a heterogenous clinical syndrome reflecting a change in cognitive function and deficits on neuropsychological testing but relatively intact activities of daily living. MCI is a risk state for further cognitive and functional decline with 5- 15% of people developing dementia per year. However, 50% remain stable at 5 years and in a minority, symptoms resolve over time. There is considerable debate about whether MCI is a useful clinical diagnosis, or whether the use of the term prevents proper inquiry (by history, examination and investigations) into underlying causes of cognitive symptoms, which can include prodromal neurodegenerative disease, other physical or psychiatric illness, or combinations thereof. Cognitive testing, neuroimaging and fluid biomarkers can improve the sensitivity and specificity of aetiological diagnosis, with growing evidence that thesemay also help guide prognosis.Diagnostic criteria allow for a diagnosis of Alzheimer's disease to bemade where MCI is accompanied by appropriate biomarker changes, but in practice, such biomarkers are not available in routine clinical practice in the UK. This would change if disease-modifying therapies became available and required a definitive diagnosis but would present major challenges to the National Health Service and similar health systems. Significantly increased investment would be required in training, infrastructure and provision of fluid biomarkers and neuroimaging. Statistical techniques combining markers may provide greater sensitivity and specificity than any single diseasemarker but their practical usefulness will depend on large-scale studies to ensure ecological validity and that multiple measures, e.g. both cognitive tests and biomarkers, are widely available for clinical use. To perform such large studies, we must increase research participation amongst those with MCI.


Dunne, R. A., Aarsland, D., O'Brien, J. T., Ballard, C., Banerjee, S., Fox, N. C., …Burns, A. (2021). Mild Cognitive Impairment: The Manchester consensus. Age and Ageing, 50(1), 72-80.

Journal Article Type Review
Acceptance Date Sep 1, 2020
Online Publication Date Nov 17, 2020
Publication Date Jan 1, 2021
Deposit Date Jul 30, 2023
Publicly Available Date Aug 2, 2023
Journal Age and Ageing
Print ISSN 0002-0729
Electronic ISSN 1468-2834
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 50
Issue 1
Pages 72-80
Public URL
Publisher URL


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