The Signs, Diagnosis and Treatment of Mild Cognitive Impairment (MCI)
Your brain, like the rest of your body, changes as you grow older. Many people notice gradually increasing forgetfulness as they age. It may take longer to think of a word or to recall a person’s name. But consistent or increasing concern about your mental performance may suggest Mild Cognitive Impairment (MCI).*
What are the symptoms of Mild Cognitive Impairment?
Your brain, like the rest of your body, changes as you grow older. Many people notice gradually increasing forgetfulness as they age. It may take longer to think of a word or to recall a person’s name. But consistent or increasing concern about your mental performance may suggest Mild Cognitive Impairment (MCI).
These issues may indicate MCI:
- You forget things more often
- You have increased problems finding words when speaking or writing
- You forget important events such as appointments or social engagements
- You lose your train of thought or the flow of conversations, books or movies
- You feel increasingly overwhelmed by making decisions, solving problems, planning steps to accomplish a task, or interpreting instructions
- You start to have trouble finding your way around familiar environments
- You have an increased tendency to misplace things and are losing the ability to retrace your steps to find them
- You become more impulsive or show increasingly poor judgment
- If you have MCI, you may also experience depression, anxiety or apathy, and changes in your mood or personality, such as increased irritability and aggression
It is common for people with memory loss to feel embarrassed and eventually to withdraw from work or social activities. Being isolated can actually worsen the impacts of MCI. Read more about the link between staying social and aging well.
* Source: Mayo Clinic
I have some memory loss. Do I have MCI?
Not necessarily. All of us have had occasions when we walked into a room and forgot why we were there. But what happens when we do? We retrace our steps and try to figure it out. The difference between normal aging and cognitive impairment is the ability to identify the issue and problem-solve the solutions.
With typical aging:
- You may experience slower recall or forget only parts of an event
- You remain able to follow spoken and written instructions
- You may have difficulty concentrating (requiring fewer distractions, less noise, etc.)
- Your capacity to learn stays intact, however new information may take longer to absorb
- You may have occasional word-finding difficulty, but are able to recall the word given time
- You may misplace an item, but you have the ability to problem-solve possible locations of the item
- You may have occasional memory issues, but not significant enough to affect daily living. For example, you may forget the name of a person who you see occasionally
Some good news for people who have been diagnosed with MCI:
- 1 out of 5 people diagnosed with MCI will go back to normal cognitive functioning within 3 – 4 years of their MCI diagnosis.
- Many people with MCI remain stable for several years without progressing to Alzheimer’s disease or dementia.
If you are experiencing symptoms beyond the slight memory loss associated with normal aging, please see your physician. If your symptoms are caused by dementia, an early diagnosis will mean early access to support and information, and the opportunity to get involved in promising clinical studies.
Can memory loss ever be reversed?
Yes! There are a number of conditions that produce symptoms similar to dementia which can often be treated:
- Vitamin and hormone deficiencies
- Depression, stress or anxiety
- Medication side effects
- Brain tumors
It is essential that a medical diagnosis is obtained at an early stage when memory loss symptoms first appear to ensure that a treatable condition is diagnosed and treated correctly.
Does everyone with MCI eventually develop Alzheimer's disease?
No, not everyone with Mild Cognitive Impairment will develop Alzheimer’s disease or dementia.
Here is the good news:
- 1 out of 5 people diagnosed with MCI will go back to normal cognitive functioning within 3 – 4 years of their MCI diagnosis
- Many people with MCI remain stable for several years without progressing to Alzheimer’s disease or dementia
Some other facts:
- Long-term studies suggest that 10-20% of people aged 65 and older may have Mild Cognitive Impairment
- As many as 15-20% of these individuals progress from MCI to exhibiting the symptoms of dementia (Alzheimer’s disease) each year. This is compared with 1-2% of the general adult population.
Is there a conclusive test that diagnoses MCI?
Not currently. According to the Alzheimer’s Association, MCI is a “clinical” diagnosis representing a doctor’s best professional judgment. There are currently no tests or procedures to demonstrate conclusively that a person has MCI.
The demarcations between normal cognition and MCI, and between MCI and Alzheimer’s, are difficult to define. Clinical judgment and cognitive testing over time is needed. Therefore, experts recommend that a person diagnosed with MCI be re-evaluated every six months to determine if symptoms are staying the same, improving or growing worse.
The Mayo Clinic web site has a good overview of MCI Tests & Diagnosis.
The Alzheimer’s Association and the National Institute on Aging (NIA) have convened expert workgroups to update the diagnostic criteria and guidelines for MCI.
I heard there are two types of MCI?
MCI that primarily affects memory is known as “amnestic MCI.” With amnestic MCI, a person may start to forget important information that he or she would previously have recalled easily, such as:
- Appointments, conversations or recent events
- The names of certain friends and/or new caregivers
- Whether a medication was taken on time and in the right dosage
- The way to familiar locations
“Nonamnestic MCI” affects thinking skills other than memory, such as:
- Ability to make sound decisions
- Ability to judge the time or sequence of steps needed to complete a complex task
- Visual perception
- Executive functioning (You can recall items, but cannot organize or categorize them, such as making a grocery list)
- Language (unable to integrate certain words into a conversation, but you can recall words in a word list when asked)
“The worried well”. These are people who seek a medical diagnosis for their memory loss but, upon testing, do not meet the threshold for MCI. That doesn’t mean they are not experiencing issues with memory loss but the cognitive issues are due to “normal aging”, stress, anxiety or other issues. Often the “worried well” can improve with therapy services and simple memory compensation strategies, such as using calendars and notepads.
What is the treatment for MCI?
No medications are currently approved by the FDA to treat MCI. Additionally, the drugs that are approved to treat the symptoms of Alzheimer’s disease have not shown any lasting benefit in delaying or preventing the progression of MCI to dementia. (Read more about current medications to treat Alzheimer’s disease in our Alzheimer’s Disease FAQ.)
However, recent research has overwhelming concluded that diet, exercise, cognitive stimulation and maintaining social relationships have beneficial effects for those who have memory loss, with amazing brain protective properties that can actually prevent the onset of Alzheimer’s for some people.
At Senior Living Residences we are proud of our innovation and foresight in creating a treatment program based on this exciting and evolving body of knowledge. The elements of our Compass Memory Support program benefit residents of our Assisted Living communities who are experiencing all stages of memory loss — from mild memory loss due to normal aging to Mild Cognitive Impairment to diagnosed Alzheimer’s disease and other dementias.
Is someone with MCI safe at home alone?
According to the Alzheimer’s Association, MCI causes cognitive changes that are serious enough to be noticed, but the changes are not severe enough to interfere with daily life or independent function. In many cases, the individual will be quite aware of his or her memory difficulties and will compensate with increased reliance on notes and calendars. Others with MCI may have mild difficulties with daily activities, such as pursuing their hobbies. For some people, MCI progresses to dementia; the resulting memory loss disrupts daily life significantly and living alone is no longer safe.
At Senior Living Residences we believe that people with MCI can function independently and deserve the right to continue to live independently, but that doesn’t mean living alone with memory loss is optimal. And yet, many seniors live alone in their homes, isolated from regular companionship, while dealing with memory loss and confusion that may gradually be worsening.
Dr. Robert Stern of the Boston University Alzheimer’s Disease Research Center says the research shows that “maintaining strong social connections may offer the biggest brain boost” of all of the lifestyle interventions that people have control over, such as exercising regularly and eating a healthy Mediterranean style diet. Staying social offers so many benefits that the Mayo Clinic lists “infrequent participation in mentally or socially stimulating activities” as one of the lifestyle factors have been linked to an increased risk of cognitive change.
We know it sounds self-serving to urge you to think about moving to a Senior Living community if you have early memory loss or MCI, but we have seen first-hand how lives have been enriched by the social, supportive, intellectually stimulating environment that a senior living community provides. We wish more people suffering silently with MCI would leave their homes to embark on a new adventure and embrace a higher quality of life for themselves, and peace of mind for their adult children!
What are the risk factors for MCI?
According to the Mayo Clinic, the strongest risk factors for MCI are:
- Increasing age
- Having a specific form of the APOE-e4 gene that is linked to Alzheimer’s (though having this gene doesn’t guarantee that you’ll experience cognitive decline)
Other medical conditions and lifestyle factors have been linked to an increased risk of cognitive change, but the evidence for these risk factors is less clear:
- Current smoking
- High blood pressure
- Elevated cholesterol
- Lack of physical exercise
- Infrequent participation in mentally or socially stimulating activities