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What is Mild Cognitive Impairment, How is it Different from Dementia, and How is Diagnosis Made?

Last Updated: September 01, 2018

 

What is Mild Cognitive Impairment?

Mild Cognitive Impairment (MCI) is sometimes diagnosed in people who have minor problems with memory, speech, or decision-making. The signs of MCI may not be obvious or noticeable and may be mistaken for normal aging. Older people who start to have memory problems may be concerned that they have Alzheimer’s disease, but if the symptoms are mild, they may be diagnosed with MCI instead. However, to be very clear, MCI is not a form of dementia.

The formal definition of MCI is: An intermediate stage between the expected cognitive decline of normal aging and the more-serious decline of dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes. (Mayo Clinic, 2017)

Mild Cognitive Impairment, in most cases, is not serious enough to interfere with an individual’s everyday activities.

There are several different subtypes of MCI, but the two major categories are amnestic (characterized by memory-related problems) and non-amnestic (characterized by issues with thinking skills that are not memory-related). It is difficult to estimate how many cases of MCI there are since there are several different definitions of MCI. According to the Alzheimer’s Association, approximately 15-20% of seniors 65 years of age and over have MCI.

 

Relationship Between MCI & Alzheimer’s Disease

Sometimes MCI is called “early Alzheimer’s disease,” although MCI does not always progress to Alzheimer’s. There is some disagreement amongst physicians and researchers about when to give a patient a diagnosis of MCI versus an Alzheimer’s disease diagnosis. The symptoms of the two can be very similar, and it is possible that the same person could get an MCI diagnosis from one doctor and an early-stage Alzheimer’s disease diagnosis from a different doctor. There is also some disagreement about when a person who was originally diagnosed with MCI, and has worsening symptoms, should be diagnosed with Alzheimer’s disease instead.

According to the Alzheimer’s Association, individuals who have been diagnosed with MCI, particularly those who have memory issues, are more likely to later develop Alzheimer’s disease or a related dementia. In fact, it has been found that approximately 32% of individuals diagnosed with MCI develop Alzheimer’s disease within 5 years.

 

Disease Progression

People with MCI are considered to be at risk for developing dementia, as previously mentioned. The type of MCI that includes memory problems (the amnestic type) is most associated with the development of dementia, especially Alzheimer’s disease.

In some cases, MCI does not worsen over time and inflicted individuals may not develop any additional symptoms or their initial symptoms may stay the same. On the other hand, some individuals with MCI do regain their cognitive abilities over time.

According to the Mayo Clinic (2017), individuals with MCI may also experience depression, anxiety, apathy (a lack of interest), aggression, or irritability.

 

Diagnosis of MCI

Currently there is no diagnostic test for MCI. Physicians use a variety of tests and assessments to rule out other possible causes of the symptoms before making a diagnosis. For example, according to the University of California San Francisco Memory and Aging Center (2018), blood tests may be done to test for conditions that are treatable that may be contributing to memory issues and dementia-like symptoms. Common blood tests include a complete blood count and a comprehensive metabolic panel, as well as testing one’s vitamin B-12 and thyroid hormone levels.

Just like for other forms of dementia, the evaluation will include an assessment of mental function as well, usually through an interview with the patient. Feedback from friends and families, neurological exams, and brain imaging may also be utilized to make a diagnosis.

Difficulty performing the Instrument Activities of Daily Living is also considered in the diagnostic process. Instrumental Activities of Daily Living,” or IADLs, are activities that we perform from day to day that add to our quality of life, but do not include basic self-care tasks (eating, bathing, using the bathroom, etc). The following tasks are considered to be IADLs:

  • Managing money (i.e., writing checks, handling cash, keeping a budget)
  • Managing medications (i.e., taking the appropriate dose of medication at the right time)
  • Cooking (i.e., preparing meals or snacks, microwave/stove usage)
  • Housekeeping (i.e., performing light and heavy chores, such as dusting or mowing the lawn)
  • Using appliances (i.e., using the telephone, television, or vacuum cleaner appropriately)
  • Shopping (i.e., purchasing, discerning between items)
  • Extracurriculars (i.e., maintaining a hobby or some leisure activities)

 

MCI vs. Normal Aging

It can be difficult to determine whether symptoms are due to normal aging, Mild Cognitive Impairment, or early stage dementia. One way to distinguish MCI from normal aging is that individuals with MCI will show signs of problems with balance and coordination. Other signs of more advanced memory-related (amnesiac) MCI include: repeating a question or story multiple times, difficulty following multi-step directions and difficulty with mathematical tasks, like managing finances. Individuals with MCI often have some difficulty with complex instrumental activities of daily living (described above).

MCI vs. Dementia

MCI is distinguished from dementia by the severity of the difficulty with everyday activities and by the presence or absence of dementia-related symptoms. Someone who has dementia will have obvious problems with activities like keeping track of medications or driving. Additionally, individuals with MCI usually do not display symptoms that are seen in dementia, such as impaired judgment or trouble with reasoning.

 

Treatment

Unfortunately, there isn’t a cure for MCI, and at this time, there are no medications that are FDA approved to treat it. However, certain medications may help improve an individual’s level of functioning. For example, medications used to treat Alzheimer’s disease may be beneficial for MCI with memory-loss (Mayo Clinic, 2017). Clinical trials are underway to evaluate the effectiveness of these medications. If psychiatric symptoms are experienced in addition to MCI, especially anxiety, therapy to address the symptom may be helpful. Since anxiety can affect a person’s cognitive abilities (problem solving, attention), in some individuals, therapy has improved both the anxiety and the symptoms of MCI.

Prevention / Slowing the Decline of MCI

Researchers have found evidence that one of the most effective forms of prevention against MCI is for an individual to control their blood pressure (DeCarli, 2003). In fact, the results of a 4-year study found that lowering the systolic blood pressure of individuals with factors of high cardiovascular risk lowered their risk of developing MCI by 19% (MDedge, 2018). Exercising on a regular basis, avoiding smoking and heavy drinking, losing excess weight, limiting caffeine, reducing stress, and eating a diet low in fat, cholesterol, and sodium all have been shown to reduce blood pressure (Mayo Clinic, 2018).

 

Suggestions for Family Members/Caregivers

  • Experts at the Virginia Tech Center for Gerontology recommend that family remain positive and encouraging toward loved ones with MCI. Other specific recommendations include:
  • Be patient. Don’t interrupt your loved ones and allow them enough time to recall information.
  • Continue to treat your loved ones like adults. This includes the way you speak to them. Don’t leave them out of conversations when you are talking about them, and avoid talking down to them.
  • When loved ones repeat a question or story, respond as if it’s the first time you’ve heard it.
  • Your loved one will benefit from continued physical and social interaction and feelings of independence and usefulness. Pets, plants and household tasks can help him/her feel needed and useful.