Mild cognitive impairment — structured clinical viva

Nosology. History and MoCA support clinical MCI / mild NCD if independence is truly preserved with compensation (dosette, limited driving). Not major NCD unless IADL independence is lost. Subtype likely amnestic pending domain mapping; specify single- vs multi-domain after detailed testing.^[1][2]

Differentials. Depression; anticholinergic burden (amitriptyline); untreated hearing loss (Lancet modifiable risk); early major NCD under-reported by patient; delirium if any acute illness (not suggested here).^[10]

Assessment. Collateral, MSE, MoCA (more sensitive than MMSE for mild deficits), functional interview, bloods, imaging once, mood and sleep, deprescribe amitriptyline if safe, hearing assessment. Capacity decision-specific (Appelbaum) — living alone does not equal incapacity.^[8][9][3]

Conversion. Elevated risk; clinic order-of-magnitude ~5–10%/year historically cited; reversion and stability occur (Mitchell). Avoid fatalism and false certainty.^[6]

Management. Lifestyle/risk-factor focus (Lancet; FINGER multidomain). No routine AChEI: Petersen 2005 (donepezil not durable; Vit E negative), Cochrane Russ, AAN 2018. Driving case-by-case. Follow-up serial review.^{[3][4][5][7][10]}