Understanding the role of psychiatrists in the diagnosis and management of mild cognitive impairment and mild Alzheimer's disease dementia: a cross-sectional survey.

Background: Alzheimer's disease (AD) is a progressive neurological disorder and the most common cause of dementia. The clinical continuum of AD ranges from asymptomatic disease to mild cognitive impairment (MCI), followed by AD dementia, categorized as mild, moderate, or severe. Almost one-third of patients suspected of having MCI or mild AD dementia are referred to specialists including psychiatrists. We sought to better understand the role that psychiatrists play in the diagnosis, treatment, and management of patients with all-cause MCI or mild AD dementia. Methods: We conducted an anonymous, online survey among physicians in the United States between February 4, 2021, and March 1, 2021. We surveyed psychiatrists, primary care physicians (PCPs), geriatricians, and neurologists who treat patients with all-cause MCI or mild AD dementia. Results: A total of 301 physicians participated in the survey, 50 of whom were psychiatrists. Of their patients with all-cause MCI or mild AD dementia, psychiatrists reported personally diagnosing two-thirds (67%). Psychiatrists used various methods to diagnose MCI or mild AD dementia including mental status testing (94%), review of patient medical history (86%), and neurological exams (61%). Upon diagnosis, psychiatrists reported most commonly discussing treatments (86%), management strategies (80%), disease progression (72%), and etiology of MCI or mild AD dementia (72%) with their patients. Most psychiatrists surveyed (82%) reported receiving advanced formal training in MCI and AD dementia care, primarily via residency training (38%), continuing medical education (22%) or fellowship (18%). Additionally, almost all psychiatrists (92%) reported receiving referrals for ongoing management of patients with MCI or mild AD dementia, primarily from PCPs or neurologists. However, only 46% of psychiatrists viewed themselves as the coordinator of care for their patients with MCI or mild AD dementia. Conclusions: Many psychiatrists indicated that they were well-informed about MCI and AD dementia and have a strong interest in providing care for these patients. They can provide timely and accurate diagnosis of clinical MCI and mild AD dementia and develop optimal treatment plans for patients. Although many psychiatrists consider other physicians to be the care coordinators for patients with MCI and mild AD dementia, psychiatrists can play a key role in diagnosing and managing patients with MCI and mild AD dementia. Plain Language Summary: Alzheimer's disease (AD) is the most common cause of dementia. Symptoms of AD include a decline in memory, language, problem-solving, and other thinking abilities that affect daily life. AD may first appear as mild cognitive impairment (MCI) but eventually progresses to AD dementia which is categorized as mild, moderate, or severe based on how much symptoms interfere with patients' everyday activities. We wanted to better understand the roles of different types of doctors in the diagnosis and management of MCI and mild AD dementia. A total of 301 doctors in the United States took an online survey in 2021. Of these, 50 were psychiatrists who specialize in mental health. Psychiatrists used several methods to diagnose patients with MCI or mild AD dementia, including mental status and memory testing. At diagnosis, psychiatrists discussed various topics with their patients who have MCI or mild AD dementia, including treatment options, ways to manage the disease, cause of the disease, and its progression. After diagnosis, most psychiatrists saw their patients with MCI or mild AD dementia at least four times a year. Most psychiatrists reported having advanced training in MCI and AD dementia care. Almost all psychiatrists said other doctors refer patients to them for ongoing management. However, less than half of psychiatrists consider themselves to be the coordinator of care for their patients with MCI or mild AD dementia. As physicians with training in MCI and AD dementia care, psychiatrists can play an important role in the timely diagnosis, treatment, and management of MCI and mild AD dementia. [ABSTRACT FROM AUTHOR]