Constructing classification boundaries in the memory clinic: negotiating risk and uncertainty in constituting mild...

Area of Science:

• Gerontology
• Neurology
• Sociology of Health and Illness

Background:

• Differentiating normal aging from pathological cognitive decline, such as Alzheimer's disease (AD), is challenging.
• Mild cognitive impairment (MCI) is a diagnostic category for individuals at risk of AD, but progression is uncertain.
• Clinical practice involves complex boundary-making between normal aging, MCI, and AD.

Purpose of the Study:

• To examine how healthcare practitioners construct diagnostic boundaries for MCI and AD in outpatient memory clinics.
• To understand how uncertainty is managed in the classification of cognitive deterioration.
• To explore the social and political contexts influencing the management of aging and cognitive decline.

Main Methods:

• Qualitative data collection from an outpatient memory service.
• Analysis of practitioners' accounts and clinical decision-making processes.
• Examination of how diagnostic categories are constructed and negotiated.

Main Results:

• Practitioners utilize the MCI classification to manage diagnostic uncertainty, enabling patient review for potential AD development.
• There is a recognized difficulty in accurately predicting future progression from MCI to AD.
• Classification decisions are influenced by both clinical uncertainty and broader socio-political factors related to aging and cognitive health.

Conclusions:

• The diagnosis and management of MCI involve navigating significant clinical uncertainty regarding future Alzheimer's disease risk.
• Practitioners' classification practices reflect a complex interplay between managing individual patient risk and broader societal perceptions of aging and cognitive health.
• Understanding these boundary-making processes is crucial for effective clinical care and policy development in dementia and aging.