Exploring modifiable lifestyle risk-talk in mild cognitive impairment diagnosis consultations: a conversation analytic approach.

Objectives: Approximately 20 % of the UK population aged ≥ 65 have Mild Cognitive Impairment (MCI), with 1 in 10 progressing to dementia. Fourteen modifiable risk factors, encompassing: less education, hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol consumption, social isolation, air pollution, and visual loss account for around 45 % of worldwide dementias. There is growing consensus that interventions targeting risk behaviours may prevent or delay dementia and reduce the likelihood that MCI will progress to dementia. Healthcare professionals, especially in memory assessment services, play a crucial role in communicating dementia risk. This study explores the placement, form, and function of discussions about modifiable lifestyle dementia risks during consultations in which individuals are being diagnosed with MCI.

Methods: The data were 43 MCI diagnostic feedback consultations, video-recorded in nine UK-based memory assessment services from 2014 to 2015. All data are British English. Conversation analytic methods were used to identify recurrent interactional practices related to lifestyle risk-talk.

Results: Clinicians lead risk-talk discussions throughout the consultations. Three activities of risk-talk were identified: (1) risk identification - clinicians elicit the nature of patient's risk behaviors; (2) risk categorisation - informing patients about the risks of dementia; and (3) risk management - clinicians recommend strategies for dementia risk reduction. Clinicians tailor these discussions to each patient, focusing on their specific risk factors, or provide generic advice in the absence of identifiable risks.

Conclusions: This study broadens the understanding of risk-talk activities and how they are delivered interactionally. It demonstrates how healthcare professionals skillfully integrate risk-talk throughout consultations while managing the inherent uncertainty surrounding health risks. It highlights the moral, interactional, and social delicacy of these exchanges.

Practical implications: Tailored messaging about lifestyle risks and modifications can be delicately incorporated throughout healthcare consultations, providing strategies for dementia risk reduction.