JMIR Publications

ABSTRACT

Background:

People with mild cognitive impairment or mild-to-moderate dementia may retain the ability to participate in preference-sensitive decisions, although cognitive decline can make complex healthcare decision-making increasingly challenging. Decision aids may support meaningful participation, but their characteristics, development, evaluation, and implementation in this population have not been systematically synthesized.

Objective:

This scoping review aimed to provide an overview of decision aids for people with mild cognitive impairment or mild-to-moderate dementia, including their characteristics, applications, evaluation, and existing challenges.

Methods:

Our scoping review was conducted following the Joanna Briggs Institute recommendations for scoping reviews and Arksey and O’Malley’s framework. The process followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) checklist. A comprehensive literature search was conducted across 6 databases: PubMed, Web of Science, Cochrane Library, IEEE Xplore, CINAHL, and EMBASE. Two reviewers independently screened titles, abstracts, and full texts via Rayyan, with disagreements resolved by a third reviewer.

Results:

Eleven studies were included, of which 10 were published from 2019 onward. Decision-support tools addressed a broad range of decisions across the care trajectory, including driving, diagnosis and prognosis, treatment and medication management, risk reduction, and future care planning. Visual formats predominated (7/11), and more than half of the tools were designed for fully self-guided use (6/11). Most tools remained at an early stage of development (10/11), with evaluations focusing primarily on usability, feasibility, and acceptability; only three studies assessed efficacy or effectiveness. Key challenges included limited integration into clinical workflows and EHR systems, digital accessibility, organizational readiness, and limited evidence across diverse sociocultural and resource settings.

Conclusions:

Decision-support tools for people with cognitive impairment are expanding across a broader range of decision contexts, reflecting growing attention to person-centred and supported participation across the care trajectory. However, most tools remain at an early stage of evaluation, with limited evidence on effectiveness, decision quality, long-term outcomes, and implementation in routine clinical practice. Future research should prioritize rigorous real-world evaluation, standardized decision-quality measures, and integration into clinical workflows across diverse populations and care settings.