Medication Management for Mild Cognitive Impairment (MCI)

Pharmacological Options

Memantine is not recommended for MCI treatment, as evidence supports its use only in moderate to severe dementia 1
For patients with vascular cognitive impairment, cholinesterase inhibitors and memantine may be considered in selected patients (2B recommendation, 89% consensus) 2, 3

Treatment of hypertension is strongly recommended for patients with cognitive disorders with vascular contributions (1B recommendation, 98% consensus) 2, 4
For patients with MCI and vascular risk factors, antihypertensive therapy should be considered for diastolic BP ≥90 mmHg and systolic BP ≥140 mmHg (1B recommendation, 96% consensus) 2, 5
A systolic BP target of <120 mmHg may be associated with decreased risk of developing MCI in middle-aged and older persons with vascular risk factors (2C recommendation, 83% consensus) 2, 3
Aspirin is not recommended for patients with MCI who have white matter lesions without history of stroke or brain infarcts (2C recommendation, 96% consensus) 2, 4

Social engagement and mentally stimulating activities should be encouraged as part of a healthy lifestyle approach 1

Treatment decisions should always be based on individualized assessment of benefits versus risks, considering the patient's overall health status and goals of care 1