BACKGROUND AND PURPOSE: Careful counseling through the diagnostic process and adequate postdiagnostic support in patients with mild cognitive impairment (MCI) is important. Previous studies have indicated heterogeneity in practice and the need for guidance for clinicians. METHODS: A joint European Academy of Neurology/European Alzheimer's Disease Consortium panel of dementia specialists was appointed. Through online meetings and emails, positions were developed regarding disclosing a syndrome diagnosis of MCI, pre- and postbiomarker sampling counseling, and postdiagnostic support. RESULTS: Prior to diagnostic evaluation, motives and wishes of the patient should be sought. Diagnostic disclosure should be carried out by a dementia specialist taking the ethical principles of "the right to know" versus "the wish not to know" into account. Disclosure should be accompanied by written information and a follow-up plan. It should be made clear that MCI is not dementia. Prebiomarker counseling should always be carried out if biomarker sampling is considered and postbiomarker counseling if sampling is carried out. A dementia specialist knowledgeable about biomarkers should inform about pros and cons, including alternatives, to enable an autonomous and informed decision. Postbiomarker counseling will depend in part on the results of biomarkers. Follow-up should be considered for all patients with MCI and include brain-healthy advice and possibly treatment for specific underlying causes. Advice on advance directives may be relevant. CONCLUSIONS: Guidance to clinicians on various aspects of the diagnostic process in patients with MCI is presented here as position statements. Further studies are needed to enable more evidence-based and standardized recommendations in the future.

Alzheimer Europe Luxembourg Luxembourg

Department of Geriatric Psychiatry University of Heidelberg Mannheim Germany

Department of Neurology and Center for Neurosciences UZ Brussel and Free University of Brussels (VUB Brussels Belgium

Department of Neurology Center for Cognitive Impairments University Medical Centre Ljubljana Slovenia

Department of Neurology Cognitive Center 2nd Faculty of Medicine and Motol University Hospital Charles University Prague Czech Republic

Department of Neurology Danish Dementia Research Centre Rigshospitalet Copenhagen Denmark

Department of Neurology Dementia Research Center Salpêtrière Hospital Sorbonne University Paris France

Department of Neurology Medical University Graz Graz Austria

Department of Psychiatry and Psychotherapy School of Medicine Rechts der Isar Hospital Technical University of Munich Munich Germany

Division of Neurogeriatrics Department of Neurobiology Care Sciences and Society Center for Alzheimer Research Karolinska Institute Solna Sweden

Reference Center for Biological Markers of Dementia Institute Born Bunge University of Antwerp Antwerp Belgium

RICE Royal United Hospital Bath and University of Bristol Bristol UK

Theme Aging Karolinska University Hospital Stockholm Sweden

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