Mild Cognitive Impairment
If you or a family member has been diagnosed with mild cognitive impairment, the diagnosis can cause understandable fear and concern. It is common to wonder about the level of help that the condition will require, now and in the future.
Mild cognitive impairment is far from rare. Between 15 and 20 percent of people over the age of 65 in the U.S. have this condition, according to the Alzheimer’s Association. If you’ve received this diagnosis, or if you think that your family member may have it, learn more about the risks and the types of support needed. Also, learn about communities, such as The Brielle, that offer the support, guidance and security necessary to help those who have mild cognitive impairment live fully and well.
What Is Mild Cognitive Impairment?
Over time, mental clarity and function changes within the brain. Some level of this is normal and natural due to the aging process. Mild cognitive impairment, or MCI, is a condition in which the amount of decline is more than is considered normal. Individuals with this condition are likely to have some language, memory and thinking difficulties. They may not make all of the right decisions, even those that may have seemed easy for them to make previously.
Some people describe MCI as feeling as though their mental function is “not the same as it used to be” or that it may have “slipped.” It is common for family members to notice subtle changes as well. While this may occur, the changes are not severe enough to significantly impact daily life. Typically, MCI does not cause unusual activities or behaviors.
Those with MCI are at a higher risk of developing types of dementia, including Alzheimer’s disease, in the future. Others with MCI don’t experience further cognitive decline. In some cases, people may even experience some improvement in memory if an underlying cause is treated.
Symptoms of Mild Cognitive Impairment
MCI is difficult to diagnose definitively, but doctors consider symptoms as a primary way of understanding the state of mental decline. Some of the most common symptoms of MCI include:
- Forgetting things more often
- Impulsiveness
- Poor judgment
- Forgetting social engagements or appointments
- Trouble finding the right words
- Losing a train of thought or being unable to continue a conversation
- Having trouble following conversations
- Trouble accomplishing tasks due to struggling with instructions
It is also likely that a person with MCI will begin to experience some emotional turmoil as a component of their condition. This may include depression, agitation, aggression, anxiety and apathy. It’s important to notice which conditions or symptoms are unusual or out of character for a person, or increasing in frequency.
Stages and Progression of Mild Cognitive Impairment
Initially, most people will not notice much of a change in their cognitive function as MCI develops. They may note some symptoms, such as forgetting things more often or running out of words during a sentence. It is common for people to associate their state of confusion with fatigue or stress.
One of the most difficult parts of MCI is how differently it presents and progresses in different people, however. Progression does not always happen. There’s not one timeline. In some cases, MCI will worsen into Alzheimer’s disease or other forms of dementia. But other people will have MCI that doesn’t progress or become life-impacting at all. The latter group remains at the same level of cognitive ability for the rest of their lives.
Causes of Mild Cognitive Impairment
There is not one known cause of MCI. This disorder does not have a clear pathway like other neurological disorders.
In some cases, there is evidence that the condition develops in the same way Alzheimer’s disease and other types of dementia occur. If this does occur, it can be due to the buildup of Lewy bodies. These are microscopic lumps of proteins that often develop in those who have Parkinson’s disease. Plaque, which consists of clumps of beta-amyloid proteins, and tangles, which are microscopic protein clumps of tau, occur in some situations. There is also evidence that small strokes can cause a reduction of blood flow to an area of the brain, triggering the episodes of impairment.
Additionally, studies of brain images of those who have MCI show:
- A higher amount of fluid-filled spaces in the brain called ventricles
- A reduction in the size of the hippocampus, the area of the brain responsible for memory
- A drop in the use of glucose, the sugar that cells use for functions
In other cases, there is no clear, easy-to-understand cause of MCI. It is rare that doctors seek the cause or have the ability to determine the cause. That is simply because there is no way to diagnose the condition definitively until after death.
Risk Factors for Mild Cognitive Impairment
Some people may be at a higher risk for developing MCI than others. The biggest factors, though, are uncontrollable. For example: age. A person over the age of 65 is most likely to develop the condition. Another example: genetics. Additionally, researchers have found that those with the APOE-e4 gene, which is recognized as the gene linked to Alzheimer’s disease, are also more likely to develop MCI. However, having this gene does not indicate the development of cognitive decline will definitely occur, just that it is more likely.
Other factors may increase a person’s likelihood of developing MCI. These factors do not definitely lead to MCI, but merely increase some people’s chances. They include:
- Diabetes
- High blood pressure, especially over a sustained period of time
- Smoking
- Elevated cholesterol
- Obesity
- Depression
Engagement of different forms — physical, social and mental — also contributes to the risk of MCI. For example, there is a link between the development of MCI and a lack of physical exercise. This also applies to social engagement: a lack of social interactions can also increase this risk. In addition, not having enough mentally stimulating activities can also increase the likelihood of developing MCI.
How Mild Cognitive Impairment Is Diagnosed
Doctors do not have a specific test to diagnose MCI. Rather, doctors gather information from the patient, as well as from family members, to determine if MCI or another form of dementia may be present. Most often, the diagnosis will be based on key factors, such as:
- If a person has experienced a cognitive decline over a period of time: this provides evidence, especially if the changes are confirmed by a family member or close friend
- If problems exist related to memory or mental function: this may include problems with planning, memory, following directions and making decisions
- If daily activities are not affected: doctors will verify that a person’s overall mental function remains intact and that daily activities are not affected by this condition, which could indicate a more severe form of dementia
There are some tests that offer insight to doctors. For example, the Mini-Mental State Examination test can provide some insight into whether mental performance has declined. Some neuropsychological testing may help determine if there is memory impairment present and its level of severity.
If cognitive decline is present, doctors will need to determine two things to indicate MCI. First, they need to note that the amount of decline exceeds that of normal, age-related decline. In addition, they need to determine that a person does not have dementia at this point. This will include looking at medical histories, gathering insight into mental status and looking at symptom severity.
A neurological exam to evaluate a person’s reflexes, eye movements and walking/balancing is often conducted. Brain imaging may be possible, especially if there is some risk of tumors, bleeding or a stroke. Doctors may complete blood work, such as looking for a B12 deficiency, which is commonly associated with MCI.
Treatment for Mild Cognitive Impairment
Treatment for MCI depends on a person’s unique needs. There is no drug for the treatment of the condition, but ongoing research may change that in the near future.
Depending on the person’s needs, doctors may recommend one or more treatment paths. For those who have memory loss as their main symptom, doctors may prescribe cholinesterase inhibitors. These are typically used to help those with Alzheimer’s disease. Yet this drug may also be used for MCI that otherwise doesn’t significantly affect a person’s day-to-day life.
One of the steps doctors will take is to monitor other health problems and to treat them as best they can. There may be some support for controlling other factors that can reduce the risk of developing progressive MCI. For example, treating factors related to memory and mental function can be an important way to reduce risks associated with MCI. This may include controlling high blood pressure. Those who have MCI may have trouble with the blood vessels in the brain. For this reason, controlling high blood pressure can be essential as it can worsen MCI symptoms. Medications and lifestyle changes may help to improve these symptoms.
Another key area of control is sleep apnea. Those who are overweight or obese are more likely to have this condition. During sleep apnea, a person’s breathing stops for periods of time due to blockage of the airway. This can prevent adequate sleep, which can lead to cognitive problems during the day.
Caring for Someone with Mild Cognitive Impairment
A person with MCI does not necessarily need care or treatment. Because this condition does not aggressively impact daily functions, it is typically not necessary to provide additional help. If the effects of mild cognitive impairment begin to affect daily life, however, that may indicate the need for care.
Everyone’s path with MCI is very different, which is why it is so important for routine monitoring over time. Some people will maintain their cognitive ability and not require additional care; other people will develop Alzheimer’s disease or other forms of dementia, and may need assisted living or memory care. Individualized attention and support is essential to the MCI patient.