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Highlights
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Mild Cognitive Impairment (MCI) – Causes,
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Symptoms and Treatment
Molli Grossman
PhD, Gerontology

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Article Highlights
Mild Cognitive Impairment (MCI) is a condition in which an individual experiences de cits
beyond the normal aging process but not as severe as Alzheimer’s or another type of
dementia
The most prevalent symptoms of MCI include forgetfulness, inability to focus and
impaired judgment
MCI is considered a prime dementia risk factor
The clearest risk factors for MCI are old age and genetic predispositions
There are three cognitive elds that are tested for MCI: episodic memory, executive
function and processing speed
MCI is a condition; Dementia is a syndrome
There is currently no speci c treatment
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Overview
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Highlights
Mild Cognitive Impairment (MCI) is a condition best de ned as the intermediate stage
ew
between normal age-related cognitive impairment and the more severe decline in
and Symptoms of
Alzheimer’s disease or another type of dementia. This intermediate phase is elusive and
ssion of MCI
slow, with the person’s rst emerging signs of mental disorder barely discernable. It is akin
s and Risk to a battery that loses its power in an unhurried and drawn-out period in between natural
s for MCI aging and the gradual dimming of signi cant cognitive faculties.
g for MCI
n Expert There is some loss of memory in this “pre-symptomatic” phase, as well as a slight
sis for MCI diminishing of language and judgment abilities, though not su cient to interfere with normal
. Dementia social functioning, or with the person’s independence and skills in performing activities of
ent for MCI
daily living (ADLs).
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g Thoughts for
Another name given to this phase is “pre-clinical”, and although it is often a precursor to
g with MCI Alzheimer’s or other type of dementia disorder, it does not necessarily lead to further
pdated with neurological decline. In fact, people with MCI may have the condition for years without
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getting worse, and some may fully recover. Naturally, these statements depend to a large
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degree on the person’s coexisting health problems and other disorders.
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Signs and Symptoms of MCI


With advancing age, the brain sustains wear and tear as well as oxidative stress, which
results from the e ect of “free radicals” or oxidants over time. Typically, we may start
forgetting names or recent events, though this forgetfulness is hardly more than a nuisance.

There may come a point however when some people experience more than simple
forgetfulness. They may forget things more often, even appointments or important
commitments they made, or they may lose the ability to focus on any task on hand, their
thought processes easily distracted. These could be early signs of mild cognitive
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impairment, and family and friends may start to notice these changes.
infographic

In addition, many people with MCI get easily overwhelmed by chores or tasks that had
previously not caused any concern. Planning a multi-step activity also becomes too
strenuous, and they may even experience di culties nding their way around familiar
grounds. Judgment may also be impaired, causing embarrassment, frustration and a loss of
self-con dence, which at times can lead to irritability, withdrawal and depression.

These signs and symptoms cause considerable anxiety, not


just for the su erers, but also for their families and loved
ones. Less prevalent symptoms of MCI include language
challenges such as:

Struggling to nd words or construct full and coherent


sentences
Focus and concentration challenges, for example in
following a trend of thought or a conversation Signs and symptoms of MCI
Progression of MCI
People with MCI have a heightened risk of developing dementia. For the
population as a whole, up to 2% of older adults develop dementia every
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year. Among older adults with mild cognitive impairment, however, research
f Contents studies have indicated that up to 15% develop dementia every year. As
such, MCI is considered as a prime dementia risk factor.
Highlights
ew
Individuals with MCI break into three categories:
and Symptoms of

ssion of MCI Some remain stable and show no change over time,
s and Risk i.e. neither recovery nor decline into dementia
s for MCI Approximately 40% recover to normal cognitive
g for MCI functioning
n Expert Others develop dementia after a few years, typically
sis for MCI within 5 years of the MCI diagnosis
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Causes and
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genetics all seem to be
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risk factors for
developing MCI, with a
person’s genes perhaps Causes and risks of MCI
being the most
prominent among
those. While not much can be done about advancing age and genes, individuals can alter their
lifestyle to reduce their risk, for example by staying mentally and physically active, not
smoking or eating an unhealthy diet, and managing or treating depression.

Risk Factors for MCI:

Age (being 65 or older)


Genes (Apoe4) or family history of MCI or dementia
Diabetes
Smoking
High blood pressure
High cholesterol
Depression
Lack of physical activity
Lack of mental stimulation

Sleep apnea, or sleep-disordered breathing (SDB), is also under consideration as potential


risk factor. It is thought that the interruption in breathing patterns during sleep may reduce
blood oxygen levels and create risk factors for cognitive decline, much like they do in causing
daytime sluggishness and heightened risk of vascular complications.

Mental acuity and stimulation at an early age, such as advancing from high school to college,
are known to reduce the risk of cognitive decline as we age. Similarly, some mentally
demanding careers, such as accounting or engineering, can also produce the same e ect of
reducing or delaying the risk of cognitive decline with older age.
In terms of the biology, current evidence suggests that MCI is characterized by the same
types of brain changes seen in Alzheimer’s disease or other forms of dementia. These
changes have been identi ed in autopsy studies and include abnormal clumps of plaques and
tangles in the brain typical of Alzheimer’s disease,
ABOUT US Lewy bodies
BECOME such as those seen
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small strokes and reduced blood ow through blood vessels in the brain.
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Highlights Testing for MCI


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Mild Cognitive Impairment may be assessed in individuals
and Symptoms of
as young as 50, yet people in the 50 to 70 range are often
ssion of MCI
averse to subjecting themselves to tests about “a little
s and Risk forgetfulness”. These concerns are more apt to be shared
s for MCI not so much with family physicians, but with friends and
g for MCI family members, and that is where the process commonly
MCI Test
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those who are more open-minded and willing to undergo tests, licensed specialists in the eld
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of psychometric assessments have been around for many years.
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g with MCI Diagnosing mild cognitive impairment can lead to evaluating a person’s risk for eventually
pdated with developing one or more of the types of dementia. There are three cognitive elds that
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comprise a fundamental test for MCI:
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Episodic memory: This involves the cognitive process of gaining, storing, and
recovering new information, and spontaneously evoking that information after a lapse of
some time. It can be of the verbal type, as in remembering the details of last night’s
dinner, or nonverbal, as in visualizing a past experience or scenes from a movie watched
a few days earlier.

Delayed recall memory is thus a subtle test for early Alzheimer’s. The rst ndings can then
be followed by other assessments that fully engage the person’s concentration, thus moving
from spontaneity to focused attention.

Executive function: This re ects on the ability to plot, outline, and observe the
completing of behaviors that are purposefully framed with a focus on speci c objectives.
Executive function also includes a sign coordinating test which necessitates decision-
making in selecting the right answer in a more multifaceted way than tests that measures
speed.
Processing speed: This re ects on mental dexterity by measuring the time span
required to cover a set number of givens. The most signi cant in uence on speed tests
have been shaped by Timothy Salthouse, PhD and Professor of Psychology at the
University of Virginia, who produced a simple “paper and pencil” test in which
participants are asked to process 20 questions as quickly as they can. The results of
Salthouse’s test can then be computerized to promptly derive results.

Ask an Expert
a Are there risk scales that identi es normal aging vs. MCI?
a How can I or my family tell if MCI is becoming Alzheimer’s disease?
a
Are there questionaires I can take to measure MCI for my loved one?

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Diagnosis for MCI
Highlights
A medical assessment for Mild Cognitive Impairment would consist of the following basic
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components:
and Symptoms of

ssion of MCI A medical history which includes a thorough documentation of the person’s symptoms,
s and Risk previous illnesses, and any family history of advanced memory issues or dementia
s for MCI Input from knowledgeable and reliable individuals who are close to the participant and
g for MCI
who can add contextual perspectives on the development to date of cognitive function
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An evaluation of performance with everyday tasks, focusing on the possible recent
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deterioration in the execution of those activities
. Dementia
An evaluation of the person’s mental functioning using brief in-o ce tests aimed at
ent for MCI
assessing memory, planning multi-faceted tasks, decision-making, and ability to
tion of the Typical
ssion of MCI adequately combine visual and spatial elements with the thinking process
g Thoughts for A physical examination to measure the function of re exes, coordination, mobility,
g with MCI balance, and sensory sharpness
pdated with And, nally, laboratory tests including brain imaging and blood tests
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ces When a methodical assessment of this type doesn’t yield a clear outcome, the physician may
recommend neuropsychological testing, as described in the above section.

MCI vs. Dementia


We rst need to di erentiate between normal aging and
mild cognitive impairment. We’re all acquainted with what
happens to us as we age: although our intelligence remains
constant, our brain and body slow down, and we take
additional time to sort things out, and the names of people
and places don’t come to us as easily as before.

In mild cognitive impairment, we start having newly


aggravating issues with memory or some other cognitive
function. Although not serious enough to signi cantly
hamper our performance in our day to day life, the issues
become noticeable to the people around us. But the worst
part is that not all, but many people with MCI are prone to go
on to develop Alzheimer’s or another type of dementia,
such as Lewy Body, vascular, or another.

Dementia is an umbrella term that includes several di erent


diseases characterized by progressive brain decline.
MCI vs Dementia
Symptoms of dementia commonly involve cognitive decline
severe enough to disrupt daily life. High on the list of such
symptoms are impairments in short term memory, language and articulation, visuospatial
function, and executive function, i.e. the ability to plan and execute on complicated matters.
They key di erence between dementia and MCI is that with dementia, there are major
disruptions in the ability to carry out daily activities, and individuals with dementia cannot be
as independent. People su ering from MCI, however, often recognize they are having
di culties but are still able to carry on most of their usual activities and continue living
independently.

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f Contents There is currently no speci c treatment for mild cognitive impairment. With currently
attempts to nd more e ective pharmaceutical drugs and better therapeutic interventions for
Highlights
Alzheimer’s disease, the results from such e orts may provide hope for individuals with mild
ew
cognitive impairment.
and Symptoms of

ssion of MCI Once the scienti c evidence points to positive outcomes from such e orts, the signi cance
s and Risk of diagnosing MCI and recognizing it early in its progression will acquire new urgency.
s for MCI
g for MCI It is also important to recognize that many drugs currently in use can have negative side
n Expert e ects on memory and other cognitive function. These drugs include Valium, Ativan, and
sis for MCI over-the-counter drugs like Tylenol PM, Advil PM, and others taken by many older adults.
. Dementia
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Some doctors will recommend medications prescribed for early-stage Alzhiemer’s disease to
tion of the Typical
ssion of MCI
help with some cognitive abilities in MCI, but research on the bene ts has been inconclusive.
g Thoughts for
Positive lifestyle changes are also encouraged, such as keeping the mind and body active.
g with MCI One research study, for example, found that walking 5 to 6 miles per week can help maintain
pdated with cognitive functioning and potentially delay the progression of MCI.
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tter!
ces Illustration of the Typical Progression of MCI
At 70, and living in the dainty city of Bennington, Vermont, Brenda L. had the beginnings of old
age issues. She at times grappled with trying to remember the rst or last names of even
some of her accustomed television newscasters and, when speaking, she would get stuck
with recalling just the word her mind sought for what she was saying.

Those, one might say, were minor issues that would at worst cause her a little frustration and
realistic recognition that she was getting on in age. But it wasn’t all that harmless, for Brenda
was experiencing precisely the same type of forgetfulness that her husband Jerry exhibited
going back some ten years.

Eventually, Brenda had to give up her job and become Jerry’s full-time caregiver.

Jerry had been a brilliant mechanical engineer and inventor. By the time he was in his 60s, he
headed the new product division of a Fortune 500 auto parts company. He had been
instrumental in obtaining sixty di erent patents for his employer.

He got up one day to give a talk to some 50 employees from other divisions of the company
only to draw a complete blank, forcing him to read from quickly jotted notes. He had relied
entirely on winging the speech, as he’d done successfully on prior occasions.

“A senior moment” Brenda thought, although Jerry admitted to great embarrassment during
the event. “It’s just your aging brain, darling,” she told her husband, with a wink and a smile.
They were both reasonably con dent individuals, and this would soon be forgotten.

But it wasn’t. As the months rolled by, his memory declined rapidly, and Jerry started talking
incoherently, stopping for long pauses as he raked his brain for the right words that just
simply wouldn’t materialize. His general practitioner knew little about cognitive decline, but he
knew enough to urge Brenda and Jerry to seek help from a dementia specialist, which they
did.
After conducting some tests of Jerry’s memory at his o ce, the specialist ordered brain
imaging and more tests. Sure enough, the diagnosis came back of mild cognitive impairment.
“We cannot be certain,” the doctor told Brenda, “but that is my judgment, based on having
seen those symptoms and tests in other patients.”
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admitted that Jerry was at high risk for developing Alzheimer’s.
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Four years later, Jerry’s cognitive function had declined to the point where he seemed to
Highlights
recognize Brenda no longer as his lifetime partner, but as a kind and familiar face.
ew
and Symptoms of
All this unfolded as Brenda herself was going through episodes of forgetfulness that
ssion of MCI reminded her painfully of how Jerry’s weakening mental faculties had developed at the
s and Risk beginning. Was she destined for Alzheimer’s too? Who would look after Jerry? Who would
s for MCI
look after both of them, if that became her predicament as well? And how long could she keep
g for MCI
Jerry at home, if and when she herself embarked on the downhill path to dementia?
n Expert
sis for MCI
These are tough questions with no redeeming resolutions. Transitioning from old age to mild
. Dementia
cognitive impairment phases raises fears of immeasurable proportions, particularly for
ent for MCI
people who have had rst hand experiences with a loved one with dementia.
tion of the Typical
ssion of MCI
g Thoughts for
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Closing Thoughts for Coping with MCI
pdated with Mild cognitive impairment can be extremely frustrating, but there are ways individuals with
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MCI can compensate for their di culties. For example, if you have MCI, be patient with
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ces
yourself and slow things down. Try to nd constructive outlets through which you can channel
your frustration, such as exercise, social interactions, or support groups. Ask your doctor for
an exercise program they’d recommend to meet your needs. There are also many steps you
can take and tools you can use to help support your memory. For example, you can use visible
reminders like writing notes to yourself, using a detailed calendar, and setting your alarm for
important events. There are also items that can be useful to have, such as automatic
dispensing pill boxes so that you can easily keep track of your medications. Most importantly,
try to focus on the abilities you do have, instead of dwelling on the abilities that have declined
and worrying about the future. There are many ways to continue to be active and productive
with MCI.

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Sources
Family Caregiver Alliance
UNC Department of Neurology
Northwestern University Feinberg School of Medicine
UCSF Memory and Aging Center
National Institute on Aging
Mayo Clinic
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