The management of mild neurocognitive disorder in primary care: A Delphi consensus study

Background Strategies to identify and treat mild neurocognitive disorder (mild NCD) are still unclear. Objective The detection and management of mild NCD are crucial to prevent or delay its progression to major NCD, and to help those affected cope with cognitive impairment. The Cartesio Project aimed to reach a consensus on the management of mild NCD in primary care. Methods The Advisory Board of five experts (three neurologists, one geriatrician and one general practitioner (GP)), identified four domains of mild NCD: case finding; differential diagnosis; non-pharmacological, and pharmacological intervention. A literature review was performed by consulting the PubMed, PsycNET and Scopus databases from 2017 until August 2022, and guidelines, reviews and meta-analyses on mild NCD were reviewed. A care pathway involving 18 statements was then proposed and voted on by 61 participants (39% neurologists, 31% geriatricians, 25% GPs and 5% psychiatrists). Results Agreement was reached on 14 out of 18 statements. The practice of case finding in primary care and the need for a two-level diagnostic approach was supported, including referral to memory clinics. With regard to non-pharmacological treatments, no consensus was reached on nutritional supplementation. There was support for the use of nootropic drug treatments, but not for drugs to treat Alzheimer's disease. Conclusions The Cartesio Project developed a consensus to identify the best care for mild NCD. The consensus highlights educational interventions on timely detection and appropriate management of mild NCD in primary care, which may be of relevance for those patients who eventually develop Alzheimer's disease.