Mild Cognitive Impairment (MCI)

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Mild cognitive impairment (MCI) is sometimes diagnosed in people who have minor problems with memory, speech, or decision-making. The signs of MCI may not be obvious or noticeable and may be mistaken for normal aging. Older people who start to have memory problems may be concerned that they have Alzheimer's disease, but if the symptoms are mild they may be diagnosed with MCI instead.

The formal definition of MCI is:
A syndrome defined as cognitive decline greater than expected for an individual's age and education level but that does not interfere notably with activities of daily life.
(Gauthier et al, 2006)

There are several different subtypes of MCI, but the two major categories are amnestic (characterized by memory-related problems) and non-amnestic. It is difficult to estimate how many cases of MCI there are since there are several different definitions of MCI. According to the results of several studies, 3-19% of adults over the age of 65 meet the criteria for MCI (Gauthier et al, 2006).

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Did You Know

Sometimes MCI is called "early Alzheimer's disease", although MCI does not always progress to Alzheimer's. There is some disagreement amongst physicians and researchers about when to give a patient a diagnosis of MCI versus an Alzheimer's disease diagnosis. The symptoms of the two can be similar, and it is possible that the same person could get an MCI diagnosis from one doctor and an early-stage Alzheimer's disease diagnosis from a different doctor. There is also some disagreement about when a person who was originally diagnosed with MCI -- and has worsening symptoms -- should be diagnosed with Alzheimer's disease instead.
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Disease Progression

People with MCI are considered to be at risk for for developing dementia, since research has shown that over half of those with MCI will develop dementia within 5 years. The type of MCI that includes memory problems (the amnestic type) is most associated with the development of dementia, especially Alzheimer's disease.

In some cases, MCI does not worsen over time. Some individuals with MCI do regain their cognitive abilities over time; in other cases, people with MCI may not develop any additional symptoms or their initial symptoms may stay the same.

Research has found that depression, anxiety, other psychiatric issues can contribute to MCI or may be a component of some forms of MCI (Gauthier et al, 2006; Beaudreau and O’Hara, 2008).


Diagnosis

Currently there is no diagnostic test for MCI. Physicians use a variety of tests and assessments to rule out other possible causes of the symptoms before making a diagnosis. For example, physicians may perform blood tests to test for anemia, vitamin deficiencies, or thyroid problems, all of which can contribute to memory problems (Mayo Clinic, 2009). Just like for other forms of dementia, the evaluation will include an assessment of mental function as well, usually through an interview with the patient.

One test that has been helpful in assessing MCI is called the Montreal Cognitive Assessment (MoCA©). Physicians may use this test in addition to performing a mental exam (Gauthier et al, 2006). The test is available at http://www.mocatest.org


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How do I know if it's MCI?

It can be difficult to determine whether symptoms are due to normal aging, MCI, or mild dementia. Physicians look at a person's level of functioning to make this determination.

Normal Aging vs. MCI

Individuals with MCI often have some difficulty with complex instrumental activities of daily living (IADL, see below). The problems might not be very noticeable and may be incorrectly attributed to normal aging. One way to distinguish MCI from normal aging is that individuals with MCI will also show signs of problems with balance and coordination (Gauthier et al, 2006). Other signs of more advanced memory-related (amnesiac) MCI include:

* Repeating a question or story multiple times
* Difficulty following multi-step directions
* Difficulty with mathematical tasks, like managing finances
(VT Center for Gerontology, 2006)

MCI vs. Dementia

MCI is distinguished from dementia by the severity of the difficulty with everyday activities and by the presence or absence of dementia-related symptoms. Someone who has dementia will have obvious problems with activities like keeping track of medications or driving (Gauthier et al, 2006). Additionally, individuals with MCI usually do not display symptoms that are seen in dementia, such as impaired judgment or trouble with reasoning (Alzheimer's Association, 2006).
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Instrumental Activities of Daily Living (IADLs)

Instrumental Activities of Daily Living," or IADLs, are activities that we perform from day to day that add to our quality of life, but do not include basic self-care tasks (eating, bathing, using the bathroom, etc). The following tasks are considered to be IADLs:

* Managing money (i.e., writing checks, handling cash, keeping a budget)
* Managing medications (i.e., taking the appropriate dose of medication at the right time)
* Cooking (i.e., preparing meals or snacks, microwave/stove usage)
* Housekeeping (i.e., performing light and heavy chores, such as dusting or mowing the lawn)
* Using appliances (i.e., using the telephone, television, or vacuum appropriately)
* Shopping (i.e., purchasing, discerning between items)
* Extracurriculars (i.e., maintaining a hobby or some leisure activities)
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Treatment

While there isn't a cure for MCI, certain medications may help improve an individual's level of functioning. For example, medications used to treat Alzheimer's disease may be beneficial for MCI with memory-loss (Mayo Clinic, 2009). Clinical trials are underway to evaluate the effectiveness of these medications; at this time, the FDA has not approved a treatment specifically for MCI.

If psychiatric symptoms are experienced in addition to MCI, especially anxiety, therapy to address the symptom may be helpful. Since anxiety can affect a person's cognitive abilities (problem solving, attention), in some individuals, therapy has improved both the anxiety and the symptoms of MCI (Beaudreau and O’Hara, 2008).


Prevention

Researchers have found evidence that one of the most effective forms of prevention against MCI is for an individual to control their blood pressure (DeCarli, 2003). Exercising, avoiding smoking and heavy drinking, and eating a diet low in fat, cholesterol, and sodium all have been shown to reduce blood pressure (Saunders, 2008).
Suggestions for Family Members/Caregivers

Experts at the Virginia Tech Center for Gerontology recommend that family remain positive and encouraging toward loved ones with MCI. Other specific recommendations include:

* Be patient - don't interrupt your loved ones and allow them enough time to recall information.
* Continue to treat your loved ones like adults. This includes the way you speak to them - don't leave them out of conversations when you are talking about them, and avoid talk down to them.
* When loved ones repeat a question or story, respond as if it's the first time you've heard it.
* Your loved one will benefit from continued physical and social interaction and feelings of independence and usefulness. Pets and plants and household tasks can help him/her feel needed and useful.
(VT Center for Gerontology, 2006)


References

Alzheimer's Association. Topic Sheet: Mild Cognitive Impairment. October 2006. Available at: http://www.alz.org/national/documents/topicsheet_MCI.pdf. Retrieved July 9, 2009.

Alzheimer's Association. Mild cognitive impairment. 2007. Available at: http://www.alz.org/alzheimers_disease_mild_cognitive_impairment.asp. Retrieved July 8, 2009.

Beaudreau SA and O'Hara R. Late-Life Anxiety and Cognitive Impairment: A Review. Am J Geriatr Psychiatry. 2008; 16:790–803.

Bennett DA et al. Mild cognitive impairment is related to Alzheimer disease pathology and cerebral infarctions. Neurology. 2005; 64:834–41.

DeCarli C. Mild cognitive impairment: prevalence, prognosis, aetiology, and treatment. The Lancet Neurology. 2003;2:15-21.

Gauthier et al. Mild cognitive impairment. Lancet. 2006; 367(9518):1262-70.

Mild Cognitive Impairment. Mayo Clinic Staff. August 2008. Available at: http://www.mayoclinic.org/mild-cognitive-impairment/. Retrieved July 8, 2009.

Saunders, E. High Blood Pressure: Tips to Stop the Silent Killer. Available at: http://www.umm.edu/features/blood_pressure.htm. Retrieved July 8, 2009.

Virginia Tech Center for Gerontology Research. Mild Cognitive Impairment (MCI): What do we do now?. October 2006. Available at: http://www.gerontology.vt.edu/docs/Gerontology_MCI_final.pdf. Retrieved July 9, 2009.