People who have Mild Cognitive Impairment are often afraid that a noticeable change in their ability to think means they are one step closer to Alzheimer’s disease. This is not necessarily true, however. MCI is not a normal part of aging, but it also does not always lead to full-blown progressive dementia like Alzheimer’s. In fact, in some cases MCI may be reversible.
On this page we’ll explain MCI, the difference between MCI and dementia, how it compares with the normal aging process, and how to manage symptoms.
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 having memory problems may be afraid it’s Alzheimer’s disease, but if symptoms are mild, they could be diagnosed with MCI.
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, 2018)
Put more plainly: Mild Cognitive Impairment is difficulty thinking that is worse than typical aging but not as bad as dementia. It is usually not serious enough to interfere with everyday activities.
There are several subtypes of MCI, but the two major categories are:
– Amnestic: Characterized by memory-related problems. Someone with amnestic MCI will forget names, places, conversations, etc., and might frequently misplace items.
– Non-amnestic: Characterized by issues with thinking skills that are not memory-related. Someone with non-amnestic MCI loses their train of thought frequently, has trouble with attention and/or focus, and might lose their sense of time and/or direction.
It is difficult to estimate how many people have MCI because there are several different definitions of the illness. According to the Alzheimer’s Association, approximately 15-20% of seniors 65 years of age and over have MCI.
Sometimes MCI is called “early Alzheimer’s disease,” even though MCI does not always progress to Alzheimer’s. There is some disagreement amongst physicians and researchers about when to diagnose MCI versus an Alzheimer’s disease diagnosis. The symptoms of the two can be so similar 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 with memory issues, are more likely to later develop Alzheimer’s disease or a related dementia. Approximately 32% of individuals diagnosed with MCI develop Alzheimer’s disease within 5 years.
People with MCI are considered at risk for 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 afflicted 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.
The causes of MCI that are NOT Alzheimer’s or a related dementia include:
– Stroke or other vascular disease
– Traumatic brain injury (TBI)
– Side effects from medication
– A health issue like insomnia, depression, or anxiety
In the cases of these last two, MCI is not necessarily progressive. This means it can be reversed, or even cured. If a medication is causing thinking issues, they might improve with alternative drugs. And if insomnia or depression are making it harder to focus or impacting memory, a person can work with doctors or therapists to cure that problem. Simple fixes like getting regular exercise or changing one’s diet could cause MCI symptoms to improve.
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, blood tests may be done to check for treatable conditions that might contribute 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 help make a diagnosis.
Difficulty performing Instrumental Activities of Daily Living (IADLs) is also considered in the diagnostic process. 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 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)
It can be difficult to determine whether symptoms are due to normal aging, Mild Cognitive Impairment, or early-stage dementia. Watch for these symptoms that are common in MCI but not normal aging:
– Problems with balance and coordination
– Repeating a question or story multiple times
– Difficulty following multi-step directions
– Difficulty with mathematical tasks like managing finances (see IADLs above).
Dementia is more severe than mild cognitive impairment. This means someone with Alzheimer’s disease or a related illness will have more problems with everyday activities, like keeping track of medications or driving, than someone with MCI. Additionally, individuals with MCI usually do not display symptoms that are seen in dementia, such as impaired judgment or trouble with reasoning.
Someone with Alzheimer’s or related dementia will also have problems with Activities of Daily Living (ADLs) that are more basic daily tasks than Instrumental Activities of Daily Living. If it’s dementia, and not MCI, the following activities will become harder:
– Bathing and/or showering
– Brushing teeth
– Going to the bathroom
– Getting dressed
Unfortunately, there isn’t a cure for MCI, and there are no medications that are FDA-approved to treat it. However, doctors sometimes prescribe cholinesterase inhibitors for people whose main MCI symptom is memory loss. (For more on cholinesterase inhibitors and other dementia medications, click here.)
Clinical trials are underway to determine if other medications might help with MCI. Among the medications being tested in trials are curcumin and pioglitazone.
If psychiatric symptoms are experienced in addition to MCI, especially anxiety, therapy may help. 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.
Sleeping problems like insomnia and sleep apnea (where a person keeps holding their breath while asleep) can cause thinking problems similar to MCI, and are treatable with therapy.
Exercise has been shown in studies as effective for helping older adults with symptoms of cognitive impairment. Exercise improves thinking ability in people with dementia, easing memory problems and psychological health problems like depression and anxiety. Exercise helps prevent decline in the first place, and when MCI becomes an issue, it is a powerful tool for helping symptoms.
Exercise obviously is not as rigorous for older adults, but almost any physical activity can be helpful. Click here for caregiver tips to help get your loved one more active.
Blood Pressure Management
Researchers have found evidence that an effective form of prevention against MCI is for an individual to control their blood pressure. When thousands of people with high blood pressure were studied over years, those who took more intense measures to control their high blood pressure had fewer cases of MCI later in life.
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.
– Remain positive and encouraging toward loved ones with MCI.
– 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.
General strategies that help caregivers support their loved one with dementia are good to keep in mind when interacting with someone who has MCI. There are proven communication techniques, ways to encourage socialization, and coping methods for emotional and behavioral issues that make day-to-day life easier for someone who is having a harder time thinking because of MCI.