Mild cognitive impairment: not much harm; not much help.

Mild cognitive impairment (MCI) represents a liminal state between full cognitive health and dementia. The diagnosis is applied unevenly and cannot be accurately prognosticated, even with the use of biomarkers, and there is no established intervention to reduce risk of progression to dementia. Owing to the limited benefit and potential for iatrogenic harm associated with an MCI diagnosis, a better understanding of its psychosocial consequences is needed. In the linked paper, Munawar and colleagues provide cautious optimism; their patients were generally unharmed by an MCI diagnosis. However, the majority of patients and families either did not recall or did not fully understand the implications for future dementia risk. Only 20% made lifestyle changes, and the number receiving hearing aids was very low. These data demonstrate the poor return on using the clinic as the setting for improving 'brain health'. Initiatives to prevent dementia are more effectively and equitably applied at population level.