Being diagnosed with mild cognitive impairment can come as a shock.
Invariably, the first thing people want to know is, does this mean I’m going to get dementia?
Ask a physician less versed in MCI, and you may be told the answer is yes.
Ask Dr. Mary Ganguli, and the answer is probably not.
And she’s got the evidence to prove it.
Ganguli and her colleagues at the University of Pittsburgh have just published a study showing that across a broad general population of adults with mild cognitive impairment, relatively few of them went on to develop dementia over a period of five years.
“Most people with MCI do not progress to dementia in the near term, but rather remain stable with MCI or revert to normal cognition,” the study says.
In fact, according to the study, of nearly 900 adults with mild cognitive impairment:
Those findings fly in the face of a widely held perception that MCI is a precursor to dementia and that if you are diagnosed with it, you are destined to progress to Alzheimer’s disease.
Dr. Ganguli is a geriatric psychiatrist at Pitt. In addition to teaching residents, fellows and graduate student there, she also does research and provides outpatient services at the University of Pittsburgh Medical Center.
She was the lead author of this study, and in a wide-ranging interview, here’s what she had to say on the topic of MCI and dementia:
“We want people to understand that not all mild cognitive impairment is MCI due to Alzheimer’s, and I think it’s come to mean that,” she told me. “In general parlance, people have come to think MCI is the stage before dementia and it isn’t.”
So where does this misperception come from? Well, in part, it depends on who you look at.
Neurologists at dementia centers typically treat MCI patients who are at the greatest risk of Alzheimer’s. So they tend to see that as the expected outcome.
But that’s a very narrow, skewed population. Most people with MCI don’t fall in that category and shouldn’t be automatically perceived as cases of dementia in waiting, Ganguli says.
“In the broader heterogeneous population, that’s not the case,” she says. “Don’t assume all mild cognitive impairment is going to progress to dementia.”
That’s just one of many observations that I gleaned during my interview with Ganguli. Here are my 10 key takeaways from our discussion, told mostly in Ganguli’s own words.
Takeaway #1: Some people with MCI are more likely to progress to dementia, and they seem to have three things in common.
Among the small percentage of people who progressed to dementia, they tended to be older, have more prominent memory loss and have the APOE4 gene, which is associated with a greater risk of Alzheimer’s.
Ganguli says these three factors represent a “typical Alzheimer’s disease profile” that’s been shown in previous studies as well.
Takeaway #2: Just as certain factors make one more likely to progress to dementia, other factors seem to make people less prone to progress.
Actually, this is one of the more significant contributions of this study. Scant research has been done to identify things that might leave someone at lower risk to progress.
“One reason we wanted to get this paper out is that people like me are the ones who are seeing the majority of these patients, and they shouldn’t believe everyone who is mildly cognitively impaired is on the threshold of developing dementia, because some are not,” Ganguli says.
“Many (studies) around the world have shown that at the population level, the majority don’t progress to dementia. But we were able to take it one step beyond that and say, over five years, these people don’t progress to dementia and here’s what else was wrong with them that might have been responsible for their cognitive impairment.”
Takeaway #3: The people who reverted to normal were less likely to score poorly on memory tests. Their problems were more focused in other cognitive domains.
The people who fell into this category were worried about memory loss, and expressed concerns about their memory, but cognitive testing showed that their memory fell into a range that’s considered normal for their age.
Based on cognitive testing, their actual deficits were in such areas as language or decision-making.
“So the people with MCI who get better might be the ones who have a lot of memory concerns to begin with, even though their memory is not impaired and other things may be impaired, and then whatever is causing those deficits might get better and then they don’t have MCI anymore,” Ganguli says.
Takeaway #4: A common factor for not progressing to Alzheimer’s is having a medical condition such as diabetes or low blood pressure.
Ganguli says these conditions are associated with cognitive problems, but they are treatable. So if they are detected and treated, perhaps that is a reason the person doesn’t progress — even if they otherwise might seem a likely candidate to develop dementia.
“Things like diabetes and depression, we consider them to be modifiable,” Ganguli says. “So improving them might improve the outcome or reduce the chances of developing a bad outcome.”
She goes on to say:
“Even in my clinical practice, I might see a person for the first time and think, this one might have some cognitive impairment, and she also has some diabetes, but the impairment looks really bad and I’m afraid this one is going to go downhill.
“But then I’ll see her three months or six months or a year later and she is not going downhill. And again a year after that, and she’s still not going downhill. And then she gets better. What happened? Well, somebody put her on an insulin pump and now her sugar is well-controlled or perhaps she had a little bit of heart failure and someone put in a pacemaker and suddenly she gets better.”
Takeaway #5: Another factor associated with not progressing to dementia is being on three or more medications.
“If you have a little diabetes or a little hypertension, you might be taking a bit of medication for that,” Ganguli says. “But here, we can specifically say that people who are taking multiple medications could be taking them for something like diabetes, so getting that treatment might have allowed them to get better, especially if it was something acute.”
Takeaway #6: Taking certain medications or combinations of medications may affect cognition in other ways, although that was not the target of this study.
“There is another factor that we didn’t go into in this paper, and that will be the subject of future research,” Ganguli says. “Are they taking medications that are making them cognitively impaired? They could be.
“ Benadryl is not a prescription medication, it’s an over the counter allergy pill which people also take for sleep, and anything with PM, whether it’s Advil PM or Alka Seltzer PM, contains Benadryl, which makes people sleepy but also does impair their cognition a little bit, and if they stop taking that, they might get better.
“There are many prescriptions that also might have this effect. Somebody recently asked me about that, and I said, ‘Are you looking at all the particular medications these people are taking that might be the cause of the cognitive impairment?’ “Obviously if you stop that medication, people should improve, so that’s something we’ll be looking at.”
Takeaway #7: Family history can play a role in your risk of progressing or not progressing. But genetics is less of a factor that you might expect. Family history also includes all sorts of lifestyle factors, and those can potentially play an even bigger role than your genetic makeup.
“You get your genes from your parents,” Ganguli says. “That is one part of family history. The ones we know that are deterministic genes — and it’s a gene mutation — if you have that gene, you will get Alzheimer’s, but that is less than 5 percent of all cases. And it is the ones that are very early onset Alzheimer’s.
“So if you have a parent or grandparent who developed Alzheimer’s in their 70s or 80s, we share genes with our parents, but we also share environment with our parents, and diet and family lifestyle with our parents, so everything that’s familial may not be genetic.”
Takeaway #8: Exercise is recommended for anyone with MCI, as a way to potentially reduce the risk of progressing to dementia.
“We really don’t understand why, but exercise seems to have a pretty big effect size,” Ganguli says. “We are working on a paper about exercise. There’s a lot of excitement about it. I don’t think can we tell people why exercise is helpful, but we can tell them that it is helpful.”
Takeaway #9: Staying socially engaged and cognitively challenged could be beneficial, too, but the evidence around that is less definitive.
“We do have information suggesting that cognitively engaging activity and social engagement are associated with a lower likelihood of progressing,” Ganguli says.
“The trouble is, you can never completely say which is the chicken and which is the egg, because people who give up playing bridge or whatever, they may be giving up because it’s getting too hard because they have an underlying disease. It’s not like they gave up, so they went unstimulated and therefore they developed dementia. It might be the other way around.
“So even though we are showing people who are cognitively normal or had MCI might be more likely to remain that way if they do certain things, it might be the ones who are able to do those things are the ones who are not progressing. In dealing with older adults, we encourage them to do those things but we don’t punish them for not doing them because maybe they are withdrawing because they are experiencing difficulties.”
Takeaway #10: There are broad risks that apply across large populations of people, but what you care about is your own individual risk. That’s unique to you, and you deserve medical treatment that is specific to you and your situation.
“We are talking about relative risk and not absolute risk at the group level,” Ganguli says. “You can’t say an individual who has diabetes is not going to progress to dementia. That’s obviously wrong. You can have diabetes and Alzheimer’s. And having diabetes might even increase the risk of having some of the pathology of Alzheimer’s or of the cardiovascular pathology, which again can increase the risk of getting dementia.
“But one would like clinicians who see someone who says, ‘I’m having trouble remembering,’ and not say, ‘That’s it, this is Alzheimer’s, I’m just going to give you Aricept or something and I’m not going to worry about your other conditions.’ We don’t want them to do that.
“We want clinicians to realize that not everyone who appears mildly impaired has an underlying progressive dementia-causing disease, although even if they do, you still need to pay attention to diabetes and blood pressure. Low blood pressure usually suggests something like either they’re taking too much blood-pressure medicine or maybe they are in heart failure, and by the way, the brain isn’t going to get enough oxygen if there isn’t enough pressure to pump it up to the brain.
“In a broad sense, it’s asking clinicians to please pay attention to all these other conditions and not say, ‘Oh, it’s Alzheimer’s and there’s no treatment for it.” Patients need to understand that. Health care providers need to understand that, and play close attention to the modifiable risk factors that people might have and not focus on the things we can’t do anything about.”
Thanks Tony. This is very hopeful news. Thank a God for people like Dr Mary Ganguli too and you who are willing to go the extra mile
Mary Lee
Yes, Mary Lee, I was very appreciative of Dr. Ganguli and her willingness to talk about this research. It’s important news that needs to be told and shared. I’m glad you took inspiration in it.
That is great Tony. As always, thank you for your good work in properly framing MCI to a more positive and truthful narrative, and helping us all to “be kind to our minds.”
Thanks for the kind words, Steve. Appreciate it. All I’m trying to provide is an honest, accurate picture of MCI because there is way too little of that out there. I hope people find it helpful.
As an84 yr old woman with the diagnosis of MCI I am hoping the research shows it does not, without fail, lead to ALZ,
Thanks for commenting, Jean, and I hope you find encouragement in this. The study makes it clear that people with MCI are not automatically destined to progress to Alzheimer’s and most don’t. I encourage you to use this as motivation to follow your doctor’s guidance and embrace health habits that can give you the best possible chance of slowing or halting cognitive decline.
Tony – thank you always for your encouraging perspective on Alzheimer’s Disease. I have been diagnosed with MCI and my mom passed at age 65 from early onset Alzheimer’s many years ago. I suffered a TBI years ago and have had several head and neck hits due to falls in pickleball. My error in going back for overheads. Don’t do that anymore.
Yet no doctor acknowledges or suggests that there is anything to be done. It’s just anxiety. So now I really am discouraged. I am struggling with my long term cognition so much more now than even the lasting effects of having no short term memory. I wanted to go to the Strong Memorial memory clinic here in Rochester NY but they won’t take me due to my TBI history. I’m 68.
Thanks for listening and I certainly would welcome your ideas.
I appreciate you leaving a comment, Claire. I have to admit, TBI and cognition is not an area of expertise for me. There’s a lot of new research and I’m keeping up with it, but it’s been hard to get a good handle on that aspect of MCI. I talked to a neuropsychologist yesterday who’s been diagnosing and treating MCI for 20 years, and she said all of the health behavior recommendations for MCI — exercise, diet, sleep, mindfulness — can benefit people whose cognitive problems relate to previous injuries as much as they benefit anyone else with MCI, so that’s one thing to focus on. Beyond that, she said the treatment is different for every person based on the type of injury and the area of the brain affected by it. So that really has to come from a doctor who has examined you and knows your medical records. I wish I could tell you more, but I hope this was at least a little bit helpful.
Very interesting article, Tony. I will be 74 in September, and have, only a couple of months ago, been diagnosed with Mild Cognitive Impairment (MCI). (I live on Bribie Island, north of Brisbane, Queensland, Australia). I have a very good memory of events etc. from years, months gone by. But ask me something about earlier this day, and the memory sometimes plays tricks on me! (If I am tired, this is worse!) I worry because my dear dad was diagnosed with what was called ‘Senile Dementia’ at the same age as I am now. It was so sad: He thought that my children were my brother and me. This was in the early 1980s, and he finished up in a special nursing home for people with dementia. It was horrible! When we visited, we had to press a buzzer for a nurse to unlock several locks to let us in. I don’t know how Dad managed it, but a couple of times he managed to ‘escape’, and the police had to find him. He passed away in his 79th year in 1984. Thank you for reading my tale of woe, Yours sincerely, Ally McRae
Thanks for sharing your story, Ally. I am touched by it. I hope you took to heart the things Dr. Ganguli said about family history. There is so much more opportunity today to understand what we are dealing with and to take steps to potentially slow or stabilize cognitive decline. I know you are doing what you can, and I applaud your effort. My thoughts are with you.
A ray of hope for those diagnosed with MCI! Armed with this information, focus can be aimed at quality of life without undue anxiety over the future.
I agree, Lynn. This is solid information drawn from real-world experience, and the picture it paints is an encouraging one. With reasonable hope, people are more likely to take action.
Tony I loved the numbered “Takeaways” that you used in this article!
Thanks, Pam. That’s really nice of you to say. I always try to keep my audience in mind when I share information. That’s why I usually do these as short videos. That’s a very good way for people with MCI to absorb information. But this needed to be an article and a long one at that, yet I’ve found that people can still follow it and get a lot out of it if they get it in a series of small points they can consider one at a time. Glad you liked it that way.
Thank you Tony – I appreciated this article. My husband was 58 when diagnosed 13 years ago & the Physician told us then only about 10% of MCI will progress to Dementia – & was happy with the strategies we were using – after 10 years there was no change in his cognition ✅ I have low blood pressure at rest but it has never been addressed medically & family history is only factor for dementia….
I appreciate your comment, Merilyn. What you describe with your husband is the kind of treatment and result that I would want to see anyone with MCI get. The study is important because it’s a measurable result involving a large number of people. Your husband’s story is just as important as the anecdotal experience of one individual that makes it feel more real and personal. You are kind to share it. It gives people hope.
I’m 55 and have NORMAL PRESSURE HYDROCEPHALUS. I was recently told I have MCI and was referred to a Neuropsychologist. I will have to wait for several months until I can get in.
I have several chronic illnesses that prevent me from getting any real exercise beyond daily stretches.
I have never been able to find any studies that explain the risks or prevalence of dementia associated with the NPH as a long term problem.
Do you know where I can go to find studies on this, or do you have any information?
Thank you!
That’s an important question, Nancy, and I’m glad to share some information.
There’s definitely an association between normal pressure hydrocephalus and dementia. But it’s also important for people to know there is treatment for this condition.
The three classic symptoms of NPH are:
• Difficulties with walking and balance
• Loss of bladder control
• A degree of cognitive loss that’s on par with mild dementia
You are asking about research, and there have been some studies, so let me share them with you.
Here’s a link to a study done by the Mayo Clinic.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265046/
Another important study is called the SINPHONI-2 trial and the results of that were reported in The Lancet. This link is below. (In this case, The Lancet only make an abstract available to the public, but there’s enough info there for it to be meaningful to you.)
https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(15)00046-0.pdf
And just in case you haven’t seen it, here’s a link to an informative and helpful story on the Mayo Clinic website:
https://sharing.mayoclinic.org/2019/02/15/puzzling-symptoms-explained-by-hydrocephalus-diagnosis/
This is so reassuring. THANK YOU!
Thanks for your comment, Jodi. I am glad you found it helpful — and encouraging. The first thing people with MCI need is hope, and this research offers them that. The odds of being able to slow, halt or reverse MCI are actually pretty good. And those odds can be made even better by embracing health behaviors that have been shown to protect cognition, particularly: exercise, diet, sleep, stress management, brain training, and managing blood pressure. Anything you focus on in those areas can only benefit you.
This is encouraging to read, thank you very much I am so happy that there are (para)medics out there that who want to help people with this discomforting and anxieting diagnoses that can greatly decrease quality of life and possibilities.
I am 34, alzheimers on both side of family starting around ±75-80. Totally without realising my GP prescribed me OAB meds, I started complaining about memory problems quiet soon after that. He ignored it. 4 years later (now) I realise how much I have lost of my used to be high gifted cognition and thinking, reasoning and analysing abilities … I had a memory as an elephant, now it is definitly more hard, I esp have word finding difficulties and writers block while academic writing used to be my profession… having a conversation is also hard, executive functions and decision making is also troubling…
They told me stopping the medication would reverse the problem. It didn’t … I also stopped with mirabegron half a year ago. It is not reversing…
If you have any thoughts on this or do know anyone who is acknowlegded in this please let me know because I will be very glad that there exists something that can help me give my mind back which I may expect to have I thought for at least some 40-50 years if God lets me too …
Thank you very much!
I want to add: I am diagnosed with MCI – taking lots of (expensive) supplements. Tested low for pregnenolone which I found to be linked to cognitive functioning but can also easily overdosed (?) so I don’t know if taking this would bring me further to my goals…
I live in Belgium. Until this point, no-one here is able to help me out in terms of giving me guidelines, tips or even can tell me what to expect…
Thanks for the comment, Anniel. Some people with MCI have complicated medical histories that involve other health conditions and medications and different combinations of medicines. Only a doctor who has examined you and knows your medical history is qualified to address those things. But for anyone with MCI, regardless of the underlying causes, adopting a healthy lifestyle can be beneficial. They keys are proper nutrition, exercise, stress management, blood pressure management and sleep. Anything you can do to address those areas will promote brain health and overall health. I encourage you to learn more by downloading the “MCI & You” guide that is available to you at the top of this page.