Mild cognitive impairment is not a disease, and it’s not a form of dementia. Rather, it’s a medical term for a degree of cognitive loss that’s concerning, but not debilitating.
Here’s how the National Institute on Aging defines MCI:
“Mild cognitive impairment is a condition in which people have more memory or other thinking problems than normal for their age, but their symptoms do not interfere with their everyday lives.”
There are two forms of mild cognitive impairment. With amnestic MCI, the primary symptom is a loss of memory. When other types of thinking skills are affected, that’s called nonamnestic MCI.
Here are answers to some frequently asked questions about MCI.
Q. How common is MCI?
A. For people over the age of 65, it’s estimated that somewhere between 15 and 20 percent have mild cognitive impairment. The risk continues to go up as we age.
Q. What are the signs of MCI?
A. Forgetting important events or appointments can be a sign, as can repeating a question over and over. You may notice a decline in ability to plan things, or solve problems. Or it may take longer than usual to come up with a word in conversation. Forgetting the names of family members or close friends can be a signal. So can issues with depth perception, such as misjudging how close one is to a traffic signal. Other signs can include a loss of interest in favorite activities, difficulty finding one’s way around in familiar settings or an increase in impulsive behavior or bad judgment. These signs may be something you notice, or that people close to you are noticing and mention to you.
Q. How can a doctor tell if I have MCI?
A. The Alzheimer’s Association website offers a good, detailed description of what goes into a diagnosis. It says the workup for MCI would include a medical history, lab tests, an assessment of daily functions, the observations of family or friends, a neurological exam and an assessment of mental status. You can read about this in more detail here.
Q. If I have MCI, does that mean I’m going to get dementia?
A. In some cases, MCI is a “pre-dementia” condition. “This means that the brain diseases that cause dementia are already established,” according to the Alzheimer’s Society. “These diseases are not generally reversible and so, in time, these people’s symptoms will worsen and their condition will progress from MCI to dementia.” However, a diagnosis of MCI does not necessarily mean you have dementia. There are many other possible causes of MCI. Some people with MCI see their memory stabilize, and some even see their memory later return to normal.
Q. Can a doctor tell if my mild cognitive impairment is an early stage of Alzheimer’s?
Science has made great strides in the early detection of Alzheimer’s. Dr. Peter Gliebus, director of the Cognitive Disorders Center at Drexel University College of Medicine, explains that the amyloid “plaques” associated with Alzheimer’s begin to build up in the brain a decade or more before people show any symptoms of the disease. In a guest post on Philly.com, he says it’s now possible to identify amyloid accumulations in the brain of someone who is not yet exhibiting symptoms of it. This is done using a special scan called an amyloid PET scan or by analyzing cerebrospinal fluid. “These significant developments allow us to look into the disease before it manifests,” he writes. These tests are relatively new, and not guaranteed to detect Alzheimer’s. But if your cognitive decline is a precursor of Alzheimer’s, the odds of your doctor being able to identify that early are much better these days. One thing experts agree on is that if you do have Alzheimer’s, the earlier it’s diagnosed, the better your treatment options will be.
Q. If it’s not dementia, what other conditions can lead to MCI, and is there anything I can do about them?
A. There are many other potential causes. Sleep apnea and depression are two possible culprits. Both are strongly associated with cognitive problems, and experts say it’s important to be evaluated for them. Memory loss also can be caused by such factors as a thyroid condition, a vitamin deficiency or adverse side effects from one or more medications. Cognitive decline also has been linked to diabetes, hypertension or other chronic conditions. If you aren’t getting physical exercise or a healthy amount of social or mental stimulation, that can dim cognition as well. The good news is that these are treatable problems. If any of these is identified as contributing to cognitive loss, it can be addressed and your memory can potentially improve.
Q. How can I tell if I’m getting better or worse?
A. Experts generally recommend that you be evaluated every six months.
Q. What are the chances that my cognition can improve?
A. Experts say that depends on a complex set of factors unique to you and your situation. There is no one set of odds for everyone; it varies widely. However, studies have found that approximately 25 percent of people who are initially diagnosed with MCI will score normal when they are assessed a second time. Some temporary factor may have caused them to do poorly on the initial assessment, but they fare better the second time, suggesting their cognition was normal all along.
AT the same time, statistics also show that about half of people diagnosed with MCI will progress to dementia over a period of five years. One recent study looked at data for 1,337 adults involved in 11 different studies on aging. About 65 percent of those people experienced some degree of mild cognitive impairment prior to their death. Among those who had MCI, about 47 percent progressed to dementia. On the other hand, about 40 percent saw their cognitive loss stabilize and stop getting worse, and roughly 13 percent had reverted back to normal memory by the time they died. So it’s not unheard of for someone diagnosed with MCI to later see their memory return to normal for their age. Still, a more realistic goal can be to take steps that improve your chances of slowing or halting further cognitive decline.
Q. Are there any medicines I can take for MCI?
A. MCI is not a disease, and there’s not a specific medicine for it. If the cause of your memory loss is a treatable condition, your doctor may prescribe one or more medicines as part of a treatment plan. Often, lifestyle changes will be part of that plan as well. It’s also important to understand that cognitive decline sometimes results from taking inappropriate medications. In such cases, less medication — not more — may be the answer. Your doctor may decide it’s best to gradually wean you off those drugs.
If your MCI is a pre-dementia condition, there are currently no drugs approved by the FDA to treat people at the stage of mild cognitive impairment. Physicians do have some latitude in prescribing drugs “off-label,” and may choose to give a patient with MCI a drug approved for the treatment of Alzheimer’s or other conditions. Meanwhile, many potential drugs are being studied right now, and clinical trials may involve patients with mild cognitive impairment as well as Alzheimer’s patients.
Q. If I’m diagnosed with MCI, should I consider joining a clinic trial?
A. That’s your decision. If you’re considering it, make sure you fully understand the risks. But people with MCI have much to gain by participating in such research, if they choose to. They may receive care at a leading medical center, usually at no cost to them. It offers access to medication they otherwise wouldn’t receive, and if the clinical trial is successful, they will have gotten a head start on treatment that others are still waiting for. People who take part in drug trials also can find it empowering to know they are helping others — and possibly themselves — by actively helping work toward a cure.
Q. How about alternative treatments for MCI?
A. Here’s what the Mayo Clinic says about that:
“Some supplements — including vitamin E, ginkgo and others — have been purported to help prevent or delay the progression of mild cognitive impairment. However, no supplement has shown any benefit in a clinical trial.”
Q. If there’s not a medicine I can take for it, is there something else I can do to slow down my mental decline?
A. A significant body of scientific evidence tells us that lifestyle choices can improve brain health and reduce the risk of cognitive decline. These include not smoking, managing blood pressure and cholesterol, being physically active, eating a healthy diet, getting enough sleep and keeping yourself mentally and socially stimulated.
The book “Dealing with Mild Cognitive Impairment” says for someone with MCI, adopting better health habits can make a difference. It says:
“Undoubtedly, it is better to have led a healthy lifestyle throughout your life, but there is good reason to believe that it is never too late to start. We advise our clients and you to make these positive healthy and lifestyle changes now. Research has shown our lifestyle choices can have a real impact on our physical and cognitive health that could prevent or delay the onset of dementia for those at risk.”
You can learn more by joining us on the Go Cogno Pathway to Better Brain Health.
Q. What can I do to cope with my memory problems?
A. There are many good tools and tactics that can help you compensate for whatever memory loss you’re dealing with. If you learn these handy devices and use them, life can become much easier. There are two handbooks you may find particularly helpful. Use the links below to learn more about these handbooks and download them:
You’re also welcome to read my post on this topic, 15 simple tricks for coping with memory loss
What questions do you have that you don’t see answered here? Please feel free to ask me, using the form below. Thanks.