(You can see the full version of the MD Magazine video featuring Dr. Bradford C. Dickerson here: Recommendations for Diagnosing Alzheimer’s Disease)
There are a lot of things that are frustrating and confusing and vexing about mild cognitive impairment.
But if there’s one question I see people with MCI struggling with more than any other, it’s this one.
What is the difference between MCI and dementia, and how can a doctor tell?
That is a very confusing thing to understand, and a very hard thing to explain.
But I just heard one of the top neurologists in the country explain it in a way that was just so clear and so simple, I had to share it with you.
Hi, I’m Tony Dearing, of GoCogno.com, the website for people with mild cognitive impairment.
Many people with MCI, probably most people with MCI, when they first got their diagnosis, they found it baffling.
MCI? What is it? I’ve never heard of it? Do I have dementia? Am I’m going to get dementia? What’s the difference between MCI and dementia anyway?
All good questions, and ones that can be extremely hard to answer. Frankly, some doctors just aren’t that good at explaining it. I know people with MCI who felt they understood less about their condition after it had been explained to them.
So it’s really a blessing when you can find a doctor who can take a very complex medical issue and lay the answer out in a way that is so clear and simple that anybody can understand it.
One like Dr. Bradford C. Dickerson, a Harvard neurologist who I just saw do that on the question: How do you tell the difference between MCI and dementia?
Now to begin with, there really is a difference, and there really are ways to tell. What Dr. Dickerson has found is a way to demystify that. So bear with me as I walk you through this, because by the time I’m done, I think you might have a clearer understanding of that.
So MCI is not a form of dementia. MCI is really just a catch-all term that says you have a loss of memory or other thinking skills that’s worse than expected for someone your age.
That’s what MCI means. Your memory loss isn’t normal. There’s something going wrong here. But you don’t have dementia, and it doesn’t mean you’re going to get dementia. Most people with MCI don’t progress to dementia.
Still, you are at higher risk, and understandably, you want to know, How can I tell? How can a doctor tell? Where is the line between MCI and dementia, and how do they know when someone has crossed it?
There is a line. It’s a fuzzy line, but it’s there. And it involves doing a functional assessment of what are called “activities of daily living.”
So what the hell does that mean, right? It’s one of those terms that doctors understand, but it’s meaningless to the average person.
What we’re talking about here is the ability to do daily tasks. Balancing your checkbook. Driving a car. Knowing to put a coat on when its cold outside. Being able to bathe yourself or feed yourself.
God knows, MCI can be hard to live with, very difficult, very frustrating. But people MCI still manage to do most of these daily tasks on their own. People with dementia need assistance with these things, and the more severe the dementia, the more help they need.
So that’s the dividing line between MCI and dementia, and obviously, that’s not a sharp line. There’s a gray area. It can be hard to tell when someone has crossed over that line.
That’s where Dr. Dickerson comes in. He has found a simple rule of thumb that doctors can use and families can use to help determine when that line has been crossed.
This is something he shared in a recent training video for physicians, offered by MD Magazine.
In the video, Dr. Dickerson starts out by saying it’s “very important” to be able to distinguish between MCI and dementia, and that the “threshold varies from person to person.”
However, he tells doctors that one simple question can help provide the answer.
He tells physicians, “What I like to ask people is, if you, as the care partner, can leave the person and go on a trip for a weekend or a week, would they function independently at things that they need to try to get done to get by in daily life?”
“If the care partner says, ‘No, I would never do that,’ you can pretty comfortably say that the person probably has crossed the threshold into dementia.”
OK, so let’s be clear about this. This is a rule of thumb. It’s not a clinical tool. It’s not a diagnosis. It’s an indicator. But a very, very helpful indicator that real people in the real world can use to understand the difference between MCI and dementia, and where a person might be in the progression, if they’re progressing.
It’s the best answer I’ve seen yet to one of the most urgent questions facing people with MCI. It’s something doctors can use and it’s something that you can watch for, and keep an eye on, too. I hope you find it helpful.
And I hope you join me again next week. Until then, as always, be kind to your mind.
The full MD Magazine video featuring Dr. Dickerson is below.
Neuropsychological testing over time (2-3 yrs) can detect the difference between MCI and dementia definitively. I am 77 yrs old and was diagnosed with MCI a year ago, but I know I do not have dementia through testing this last September. Also, since dementia progresses about 4% per year and I f I do develop Alzheimer’s, it’s not likely to impact my life significantly.
Thanks for the great comment, Jim. I appreciate you describing your experience, and what you have to say can help other people. Through this testing you’ve been through, you have gained an advantage that many people with MCI don’t have. You know what you’re dealing with, and you know it’s not Alzheimer’s. I’m sure you were relieved to find that out, and I’m happy for you. Your perspective is a valuable one, and I thank you for sharing it with others.
I was diagnosed with MCI, and a later exam said I have Alzhiemers. I do not see any difference in my ability to remember things due to this shift, so is it possible that I do NOT have Alz., but instead an incorrect diagnosis? Thank you.
Good question, Jim. There is a gray area between MCI and dementia, and I have certainly seen instances where a doctor has diagnosed dementia, but when the person got a second opinion, the diagnosis was changed to MCI. The distinction between MCI and dementia has a lot to do with autonomy. The fundamental question is: are you able to take care of yourself for the most part, or do you need the help of others to care for you? You have a right to have your diagnosis explained by you. Why did the doctor conclude it is dementia? What was that based on? If you question whether the diagnosis is accurate, you have a right to seek another opinion. Whatever stage you are at right now, you still have the potential to affect the course of your cognition by taking a positive attitude, living with purpose and embracing healthy behaviors.
I think that this explanation is similar to one that I have heard before, but I have no clue where I heard it. I had read or told that MCI means that I don’t have dementia, but that my brain doesn’t work like most people my age.
Yes, Cheryl, you got that exactly right. Having that understanding can be so helpful.
This is the most straightforward explanation I’ve seen. Thank you, Tony!
Thanks, Pam. These things really are understandable, if they’re presented in the right way. My goal is to give people with MCI the deepest possible understanding of what they are dealing with, and I’m glad you found this helpful.
So in regards to someone who can be left alone for a weekend or a week. They are no longer able to drive. They have no responsibilities at the home. That includes balancing the checkbook, or paying bills. But they can make food if its in the fridge, or have food delivered. They get a bit confused with their medicine, but when they take their time they can figure it out.
Tony – I wish I had viewed this video before the one on balance (which by the way was great). Having been diagnosed with MCI sometime ago and with Alzeheimer’s running in my family – your explanation of the line between the two was so eye opening to me – I thank you. I have struggled with this for years due to my family’s history – and being a TBI survivor on top of that only compounded my situation. This was truly a gift! Claire
I appreciate the comment, Claire. I do believe these kinds of explanations can be helpful, and that’s why I was so eager to share it. I’m glad it’s still reaching people, and that you found it valuable.
My question is what is what when your neuropsychologist Diagnosis MCI and a PET scan diagnosis dementia?
That is a very complicated question, Kristi, but I will try to answer it in a straightforward way. There is a diagnosis called MCI due to Alzheimer’s. That is what doctors call it when the amount of cognitive decline is at the MCI level, but the underlying cause is believed to be Alzheimer’s. At that point, it’s an educated guess. But a PET scan takes the guess work away. It can detect the amount of amyloid plaque in the brain, and depending on what that level is, it can indicate Alzheimer’s. At that stage, the Alzheimer’s has not yet developed into dementia. It’s still milder than that, so it would be classified as MCI, and a neuropsychologist is trained to make the diagnosis. For some people with MCI, the underlying cause isn’t Alzheimer’s. It’s something else. They will not progress to Alzheimer’s because they don’t have Alzheimer’s. When the underlying cause is Alzheimer’s, there are doctors who believe it still is possible at the MCI stage to prevent that progression to dementia from occurring and it is an admirable goal to aggressively defend one’s cognition and do everything possible to slow or halt the cognitive decline.
Thanks for this useful site. I have liver disease from obesity. As a result I have hepatic encephalopathy where ammonia and other toxins can cross the blood/brain barrier and cause dementia like symptoms. The HE is reasonably controlled by two medications. I still drive, grocery shop, pay my bills, cook meals.
However about two years ago I began having trouble doing my engineering job in the defense industry. I was making more and more mistakes, forgetting instructions and conversations with my manager. They were beginning steps to fure me.
I have had neuropsych eval and it shows I am struggling in areas of short term memory, executive function, all the things that let you do high-level knowledge work. I told the examiner that I felt like a kid with severe ADD and thats what my testing show. I have a diagnosis of congitive impairment secondary to my liver disease. I am receiving pay through my company’s disability insurance.
Thank you for sharing your story, Lee. You have serious medical challenges, but I hope you can appreciate how important it is to have a clear understanding of the cause of the cognitive impairment, because then you can focus on that. So many people with MCI don’t have that clarity, and having it is an advantage. In addition to the way your condition is being treated medically, anything you commit to do about lifestyle changes can benefit you as well. Please know that my thoughts are with you.
I was diagnosed with MCI in December of 2020. Prior to that I was a high functioning accountant, overseeing the entire business operations (accounting, financial reporting and analysis, Human Resources, payroll and employee benefits) at a private school. In October of 2020 is when things started to notably surface. Such as asking what time my wife and I were leaving for an appointment three or four times within an hour. Not remembering what the day of the week was, or the numeric date, and not remembering conversations. I scored poorly on the MOCA test, then again on the SLOCUMS test. A neuropsychological test was performed that showed more concern besides memory, such as having attention problems. I have had over 70 visits to my healthcare team and have traveled over 7,000 miles during this time. The last few appointments, which I hope are the final ones, were a PET scan and a lumbar puncture. I am so exhausted and want to be left alone. I have lost my career, my job, and at age 54, I am disabled and on long term disability. To say this bluntly, this sucks. So much has been taken from me in such a short time, it’s almost hard to believe. My counselor has spun this as early retirement. I can, at times, think that way but it feels foreign to me as it wasn’t on my terms.
Mark, I admire your honesty, and your willingness to so openly express what you are facing and what you are feeling. No one should try to deny or minimize that. It is real and it is hard. Because this is all so recent and so raw, what it’s hard to see right now, but you will discover, is that there’s a journey ahead of you, and in that journey, you will find an acceptance and an ability to continue and to cope that seems hard to imagine right now. Only time can give you that perspective, but it will come. From what you describe, you have access to good medical care and that is such an advantage. And it heartened me to hear you reference your counselor. That says you understand the emotional toll of this has to be properly addressed, just as the medical aspects do. I can tell from the description of your past professional life that you are blessed with resilience and resourcefulness and those qualities will serve you well. Now is a particularly important time to commit to self-care and self-talk. In addition to what you’re already doing, you might consider: journaling, a meditation practice, long walks in nature, music therapy, things along those lines. Please know that my thoughts are with you.
I am my husband’s care giver. I am so confused by the changes I have seen in the last two and 1/2 years. We were told yesterday that there was no amyloid plaque found on his PET scan. We were grateful for this news, but I am still perplexed by the decline in his ability to correctly recall conversations, whether he has taken his medication, etc. His demeanor has changed. He requires more and more sleep. We have lived in the same home for more than 22 years. Last night I asked him to take the vacuum to the den. He replied, “Help me out. Which room is that?” I was floored that he needed help with that. I find that time of day is important with him. At the end of the day, he has zero brain power. He is easily triggered by certain commercials on TV and or current events in the news. Once he sleeps, it seems to break the cycle. The guy who goes to work may or may not be the guy who comes home.
It is a blessing to have Alzheimer’s ruled out, and I know you realize that, Vicki. Yet the symptoms of cognitive impairment remain, as do the challenges of coping with them, which you lay out so articulately here. It begs the question, what are the next steps? What additional evaluation has been done or will be done to better identify the possible cause of this, if it’s not Alzheimer’s? What are the treatment recommendations? Your husband still needs a diagnosis that he and you understand and can act on, and treatment options appropriate for him. I will tell you that I have seen people who didn’t have Alzheimer’s make progress, even if that progress is in slowing the decline, whey they are given an aggressive treatment plan tailored individually to them and their unique strengths and vulnerabilities. Anything you are able to do to advocate for that can be beneficial.