AAN guideline for patients with mild cognitive impairment

Clinical Question

How should clinicians manage patients with mild cognitive impairment?

Bottom line

Mild cognitive impairment (MCI) follows a variable course: not all patients progress to dementia. The data on pharmacologic interventions are limited and, so far, not very encouraging. Of the nonpharmacologic interventions, the best, albeit limited, data support exercise. 5

Study design: Practice guideline

Funding: Foundation

Setting: Outpatient (any)


Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI

Discuss this POEM



Good poem. Thanks for highlighting ties to industry among panel members.


Good poem


As an increasingly forgetful 60 year old, I am reassured that descent into marked dementia is not a certainty!


Good to learn that medications are not as robust as we had hoped they were.
I am a strong believer in physical activity, when possible.
I wonder if music along with the activity would provide for more benefit


Medication don't work for decline which results from a lifetime of hyperinsulinemia from following the soya / seed oil & sugar industry funded SAD, for either "Standard American Diet" or more correctly "Sick and Demented". Hyperinsulinemia affects many organs. In 1965 (I was in diapers) it had already been observed that those who were obese, hypertensive, or had myocardial infarctions, had elevated fasting insulin levels. This was before Economist / fish physiologist Angel Keyes convinced the world that saturated animal fats were the enemy.

Dementia has been clearly associated with hyperinsulinemia. Insulin crosses into the CSF via transporter proteins and stimulates receptors in the hypothalamus. Insulin stimulates immune system cells and when chronically elevated has a pro-inflammatory effect. Insulin stimulates cells involved in atheroma formation. Insulin promotesthe production of large Triglyceride rich VLDL, which become small dense atherogenic LDL.

Mildly Demented seniors switched from porridge to eggs & sausage or bacon (from high carbohydrate to ketogenic) diets showed improved memory after a few months, in a 2015 study.

The solution to hyperinsulinemia is simple, reduce the ingestion of sugary & starchy foods.


Interesting that 15-30 % of patients with MCI return to normal. Also this study confirms that there is no clear evidence for the use of pharmaceuticals for MCI.