• Deborah A Levine, Andrzej T Galecki, Brenda L Plassman, Angela Fagerlin, Lauren P Wallner, Kenneth M Langa, Rachael T Whitney, Brahmajee K Nallamothu, Lewis B Morgenstern, Bailey K Reale, Emilie M Blair, Bruno Giordani, Kathleen Anne Welsh-Bohmer, Mohammed U Kabeto, and Darin B Zahuranec.
• Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA. deblevin@umich.edu.
• J Gen Intern Med. 2022 Jun 1; 37 (8): 192519341925-1934.

BackgroundOlder patients (65+) with mild cognitive impairment (MCI) receive less guideline-concordant care for cardiovascular disease (CVD) and other conditions than patients with normal cognition (NC). One potential explanation is that patients with MCI want less treatment than patients with NC; however, the treatment preferences of patients with MCI have not been studied.ObjectiveTo determine whether patients with MCI have different treatment preferences than patients with NC.DesignCross-sectional survey conducted at two academic medical centers from February to December 2019 PARTICIPANTS: Dyads of older outpatients with MCI and NC and patient-designated surrogates.Main MeasuresThe modified Life-Support Preferences-Predictions Questionnaire score measured patients' preferences for life-sustaining treatment decisions in six health scenarios including stroke and acute myocardial infarction (range, 0-24 treatments rejected with greater scores indicating lower desire for treatment).Key ResultsThe survey response rate was 73.4%. Of 136 recruited dyads, 127 (93.4%) completed the survey (66 MCI and 61 NC). The median number of life-sustaining treatments rejected across health scenarios did not differ significantly between patients with MCI and patients with NC (4.5 vs 6.0; P=0.55). Most patients with MCI (80%) and NC (80%) desired life-sustaining treatments in their current health (P=0.99). After adjusting for patient and surrogate factors, the difference in mean counts of rejected treatments between patients with MCI and patients with NC was not statistically significant (adjusted ratio, 1.08, 95% CI, 0.80-1.44; P=0.63).ConclusionWe did not find evidence that patients with MCI want less treatment than patients with NC. These findings suggest that other provider and system factors might contribute to patients with MCI getting less guideline-concordant care.© 2021. Society of General Internal Medicine.

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