What is Mild Cognitive Impairment? Here’s Everything You Need to KnowNov 08, 2022
Over the years, I’ve worked with a lot of people with Mild Cognitive Impairment. While it can be super frustrating to navigate, to receive a diagnosis and to have a name for what you’re experiencing, it’s very valuable to pursue help in this stage of memory and cognitive change.
In this article, you will learn:
- What is Mild Cognitive Impairment?
- Signs and symptoms
- The two types of Mild Cognitive Impairment
- Causes and risk factors of MCI
- How MCI is diagnosed and advocating for proper diagnosis and support
- Prevalence and prevention of MCI
- What to do after a diagnosis of MCI
Adults experiencing problems with their memory or thinking that extend beyond typical age-related change may have a condition called Mild Cognitive Impairment.
What is Mild Cognitive Impairment?
Mild Cognitive Impairment, or MCI, is an early stage of memory or cognitive ability loss in individuals who maintain the ability to independently perform activities of daily living. It's characterized by subtle changes in memory or thinking that are sometimes confused with normal aging, however, these changes are not a typical part of the aging process.
Mild Cognitive Impairment is more than normal aging.
Mild cognitive impairment describes a collection of symptoms impacting clear thinking, memory, problem solving, judgement and language. People with MCI are still able to do all their normal activities and live independently, yet the symptoms are significant enough to be noticed by not only the person affected but also by those close to the person, like family and friends.
With typical age-related change, people tend to forget trivial things, such as where they put their glasses. But people with MCI are prone to forget more important details such as an upcoming appointment, how to log in to a zoom call, or where their granddaughter lives. Even so, it's referred to as 'mild' cognitive impairment because it does not significantly impact day to day functions like driving, preparing food or taking care of themselves.
Signs and Symptoms of Mild Cognitive Impairment
- Losing things often.
- Forgetting appointments or events.
- Frequently losing train of thought in conversation.
- Feeling increasingly overwhelmed by making decisions, planning steps to a task or understanding instructions.
- More impulsive with decision making.
- Having more trouble finding right words than others at the same age.
- Taking longer to process information or complete previously automatic tasks.
Additionally, someone with MCI may:
- Feel more frustrated or anxious with their memory or thinking.
- Worry others around them are noticing changes, too.
- Try to hide changes or withdraw from situations in which these changes may be evident.
- Deny changes and resist help.
- Experience fear about what these changes mean for them.
What if it’s not evident enough for others to notice?
If you’re experiencing memory changes that are present but appear less evident to those around you than those listed above, you may have a Subjective Memory Impairment. A subjective memory impairment is the self-reported worsening of memory or thinking skills. It may affect how you think and feel, but it may not be serious enough to be recognized by others around you.
In a subjective memory impairment state, it is equally as important to address your concerns to avoid progression into a more significant or intrusive problem.
What to do if you suspect cognitive changes
If you or a loved one is experiencing cognitive changes, or you suspect mild cognitive impairment, it's crucial to schedule an appointment with your primary care physician. With rates of cognitive decline rapidly increasing, appointments to be seen by a specialist can be booked out for several months at a time.
At the first signs of change, schedule an appointment for as soon as possible to avoid a year-long wait list. Even if something changes, you'll at least have your appointment in the books.
The Two Types of Mild Cognitive Impairment
There are two types of Mild Cognitive Impairment that can be classified based on the individual’s symptoms. The two types of Mild Cognitive Impairment are:
- Amnestic MCI
- Non-amnestic MCI
Amnestic MCI refers to those with memory impairments as their primary symptom. Those with amnestic MCI may be more prone to:
- Misplace items
- Forget conversations
- Repeat themselves
- Difficulty communicating thoughts and ideas clearly
Individuals with non-amnestic MCI may experience other cognitive issues such as impaired problem solving, language, executive functioning, or visuospatial abilities. This may show up as:
- Difficulty maintaining train of thought
- Unable to focus and maintain attention
- General disorganization of thoughts and ideas
- Increased impulsivity in decision making
- Changes in spatial awareness
- Finishing everyday tasks effectively, such as paying bills or managing accounts
People who experience both memory and other cognitive changes are said to have multi-domain MCI.
Causes of Mild Cognitive Impairment
A variety of factors can cause Mild Cognitive Impairment, some of which are temporary while others may be more difficult to get to the origin.
MCI can occur as temporary result of immense stress, sleep deprivation, depression or as a side effect from a medication. For some, MCI is the transitional state between normal aging and dementia. MCI shows up years before dementia symptoms and progression can vary greatly from person to person.
It’s important to state that mild cognitive impairment is not dementia, however, people with MCI are at a higher risk of developing dementia. Additionally, a separate diagnosis can be made for MCI due to Alzheimer’s disease.
Mild Cognitive Impairment due to Alzheimer's Disease
MCI due to Alzheimer's Disease is the symptomatic precursor to Alzheimer’s dementia. This occurs due to distinct biological changes in the brain.
However, not everyone that has Mild Cognitive Impairment due to Alzheimer's disease will go on to develop Alzheimer's. Research suggests that after 5-10 years of a diagnosis of MCI due to Alzheimer’s disease, roughly 30-50% of people will go on to develop Alzheimer’s disease.
This is where diagnosis and early intervention is critical. Intervening early allows for the best possible outcome with medical intervention, lifestyle changes and support to optimize health, happiness and quality of life. Lifestyle prevention methods are the most effective way to prevent, stave off or halt progression to dementia.
Risk Factors for Mild Cognitive Impairment
There are many risk factors for MCI. While age is a risk factor, it's important to note that MCI is not limited to people over the age of 60.
Risk factors include:
- High blood pressure
- High cholesterol
- Living a sedentary lifestyle or lack of exercise
- Not engaging in mentally stimulating activities
- Not socializing
- Having the biomarker of the APOE-e4 gene, which is linked to Alzheimer’s disease
Many of these stated risk factors overlap with the 12-modifiable risk factors for dementia, which can greatly reduce your risk dementia.
MCI can also result from other injuries or disorders such as:
- Traumatic brain injury (TBI)
- Vascular disease
- Psychiatric disorders
- Neurologic disorders
Prevention of Mild Cognitive Impairment
While it can’t always be prevented, adopting healthy habits can reduce your risk of cognitive decline. Prevention measures may include:
- Avoiding alcohol use
- No smoking
- Limiting exposure to air pollution
- Managing other health conditions such as hypertension and/or diabetes
- Healthy sleep hygiene
- Eating a nutrient rich diet
- Engaging socially
- Addressing hearing loss
- Engaging in cognitively stimulating activities
How is Mild Cognitive Impairment Diagnosed?
There is no specific test to determine if someone has MCI. This is an area where I frequently see gaps in the healthcare system and a wide range of methods for diagnosing this condition. In other words, what should happen isn't always what does happen. For this reason, having more information on common signs/symptoms and what to expect can make all the difference.
Your primary doctor can diagnose MCI by assessing your reported symptoms. Factors they will consider:
- You present with memory or other cognitive problems related to decision making, problem solving, clear thinking, planning, and following directions.
- Your health history, any prior illnesses, or injuries as well as your family health history.
- How evident and persistent the problem is. Remember, a key feature of MCI is that it’s significant enough for the people around you to notice the changes, too.
- Your cognitive function is not interfering with your ability to complete daily activities, though they may be more frustrating, challenging, or worrisome.
- Cognitive screening shows mild cognitive impairment for your age and education level.
- Screening tools may include the Mini-Mental Status Examination (MMSE), the Montreal Cognitive Assessment (MoCA) or the Saint Louis University Mental Status Examination (SLUMS).
- Your signs and symptoms are more typical of MCI rather than dementia.
Your primary care physician may refer you to a specialist.
Specialists involved in diagnosing and/or follow-up for mild cognitive impairment include:
- Neurologists, they specialize in diseases of the nervous system and the brain
- Psychiatrists, they play a role in mental health and aging
- Psychologists, they have training to assess thinking skills, problem solving, memory, attention, language, etc.
- Geriatricians, they specialize in the care of older adults and dementia
The gold standard of testing should also include:
- A neurological examination to assess how well your brain and nervous system are functioning.
- Brain imaging with an MRI and/or CT to rule out other neurological causes for your symptoms, including Parkinson’s disease, strokes, tumors, etc.
- Lab tests to rule out other problems or deficiencies, such as a B12 deficiency.
- A neuropsychological testing to assess your cognitive function compared to typical aging and to identify patterns that may provide more insight into your challenges and the underlying cause of these changes.
Advocating for proper diagnosis and support
Memory loss and cognitive changes are invisible illnesses, which can occasionally result in less attention from your physician when you express concerns.
A large part of my practice as a memory health coach is empowering people experiencing memory changes to address their concerns directly and to advocate for support. You deserve for your concerns to be heard, addressed, and properly tested.
As we know, early intervention for memory or cognitive changes allows for the best chance to make improvements, modify lifestyle, and support clear thinking to prevent, stop or reverse MCI. For this reason, it’s critical to ask questions, request further information and advocate for support.
According to the Alzheimer’s Organization facts and figures report, physicians vary greatly in their level of understanding, confidence, and consistency when it comes to diagnosing Mild Cognitive Impairment.
Here are some key statistics about physicians and MCI:
- An overwhelming majority of PCPs surveyed say it is important to diagnose MCI (98%) and MCI due to Alzheimer’s disease (90%). One-third of PCPs (35%), however, are not fully comfortable diagnosing MCI and more than one-half of PCPs (51%) say they are not fully comfortable diagnosing MCI due to Alzheimer’s disease.
- When making an MCI diagnosis, the most frequently cited challenges by PCPs include difficulty in differentiating MCI from normal aging (72%) and difficulty in interpreting patient reports of daily functioning (51%).
- PCPs say early intervention can slow progression of cognitive decline, but many are unfamiliar with clinical trials and research advances that may help diagnose and manage MCI and MCI due to Alzheimer’s disease now and in the future.
While we continue to make advancements toward understanding and talking about Mild Cognitive Impairment, it is critical to advocate for yourself or your loved one to receive the support you deserve.
If you're not confident that you've have the gold standard for assessment or you feel as though your physician has not been receptive to your concerns, consider searching for a dedicated memory health center in your area. Many cities have memory centers that focus primarily on cognitive and memory concerns. You can lookup memory clinics or centers in your area to find the best fit for your needs.
As a memory health coach, I work with many people and families navigating Mild Cognitive Impairment. If you need more information or support, you can contact me here or schedule a call with me directly to learn more about how memory health coaching can help.
Preparing for your appointment
You will most likely schedule an appointment with your primary care physician (PCP). Your PCP may assess you themselves or refer to a specialist such as a neurologist or a neuropsychologist.
It’s important to be prepared for your appointment so you can express your concerns clearly and make the most of your time with your doctor or specialist.
Considerations to help you prepare for your appointment:
- Ask ahead of time if you should plan to complete blood work or other labs prior to the appointment.
- Bring a list of all your current medications and the dosage, including vitamins and supplements you are taking.
- Have a close family member or friend accompany you, especially if they can provide supportive information regarding the changes you’re experiencing.
- Write down all your symptoms. Be specific and provide examples of what you’re experiencing, when it started, and any indication that is it getting worse. Comment on any patterns that you’ve noticed or the reasons you believe it is happening.
- Keep a list of questions you may have. As we know, time with doctors can be fleeting. It’s important to have the questions you want to ask ready and available to you. If you run out of time, you can also follow up by emailing your list of questions.
Common questions you may have for your doctor:
- What tests do I need? When can I schedule them?
- Do you know what could be causing my memory problems?
- Do I need to see a specialist? Is testing covered by insurance?
- What can I expect to come next?
- Do you have any resources that I can take home with me?
- What can I do between now and when I see you next?
You will likely be seen for several follow up appointments, don’t allow that time to go by without trying to make changes to support clear thinking! Ask for resources, websites, books or articles to help you get started on making changes to your diet or incorporating more physical exercise. Ask for referrals for therapy or invest in working with a coach who can help you make the right changes.
What to expect from your doctor
Your doctor should have questions for you about what you’re experiencing. Being prepared to respond to their questions can help you stay focused for the appointment to meet all your needs.
If you’re having trouble with word finding or expressing your thoughts clearly, having a close family member or a friend accompany you can be very helpful. Discuss your concerns with them at length prior to the appointment to be sure you’re on the same page.
Questions your doctor may ask you:
- What kind of problems are you having? When did they start?
- Can you give me some examples of what you’re experiencing.
- Are these problems staying the same or do you feel they are getting worse?
- Are you experiencing any sudden changes in your mood?
- How are you sleeping?
- Do you have less energy than you used to?
- What medications are you taking? Have they changed?
- Do you drink alcohol? If so, how often and how much?
- What other medical conditions do you have?
- Have you noticed any other changes in your health?
- Are you steady while walking? Do you have any trembling or balance concerns?
- Have you had your vision or hearing check lately?
- Has anyone in your family had memory problems that you know of?
Prevalence of Mild Cognitive Impairment
According to the Alzheimer’s association facts and figures report, an estimated 12-18% of people over the age of 60 are living with MCI. Approximately 10-15% of individuals living with MCI will go on to develop dementia.
Mild cognitive impairment can also affect people under the age of 60. While statistics are unclear on how common MCI is in your 30s-50s, it is still important to address concerns with your physician at any age.
In my memory health practice, I meet people regularly who receive this diagnosis before the age of 60 for all different kinds of reasons. Sometimes, MCI is used to describe a collection of symptoms in the absence of any other diagnosis. Regardless of the origin of MCI, seeking help and support for lifestyle interventions is an important next step.
Treatment for Mild Cognitive Impairment
Currently, there are no medical treatments for Mild Cognitive Impairment. Occasionally, doctors will prescribe dementia medications for those experiencing memory loss that may help slow progression of decline. However, this is not a typical treatment for MCI, and it can come with many side effects.
Your doctor may also prescribe speech therapy for memory to develop memory strategies and cognitive tasks to support recall and problem solving.
Reversible causes of MCI
There are certain conditions that can result in temporary cognitive impairment. In many cases, if the underlying conditions are treated, it can resolve the cognitive impairment.
Reversible causes may include:
- Side effects from medications
- Sleep apnea or deprivation
- Anxiety and depression
- High blood pressure
According to the Mayo Clinic, here are some medications that may result in cognitive impairment as a side effect:
- Benzodiazepines which are used to treat conditions such as anxiety, seizures and sleep disturbances
- Anticholinergics, which are prescribed for a number of reasons and can affect the nervous system
- Antihistamines, often used to manage allergy symptoms
- Opioids, often used to treat pain
- Prolonged use of proton pump inhibitors, often used to treat reflux or gastroesophageal reflux disease (GERD)
It’s important to discuss any side-effects with your doctor and to always consult with the prescribing physician before making any changes to your medications.
Additionally, your doctor may refer you to other specialists for help resolving or managing the causes or signs/symptoms you're experiencing. This list of professionals can include:
- Sleep specialists
- Therapists, including occupational, physical or speech therapists to address symptoms or challenges
- Memory health coaches that can guide you through lifestyle changes to support clear thinking, and slow or resolve cognitive decline
Does MCI always lead to dementia?
While a diagnosis of MCI does increase your risk, mild cognitive impairment does not always progress into dementia.
An estimated 10-15% of people with mild cognitive impairment will develop dementia each year. However, there is high variability in the severity and trajectory of MCI. It may worsen, stay the same or even resolve, depending on what's causing it.
It’s important to act with lifestyle changes to optimize cognitive health and function.
The biggest mistake I see people make after a diagnosis of Mild Cognitive Impairment
Typically, after a diagnosis of MCI, you continue to have follow-up appointments to monitor for changes or progression. As a memory health coach, the biggest mistake I see people make after receiving a diagnosis of MCI is not changing anything.
If nothing changes, nothing will change. We can’t expect to see any improvement or to stop the progression without making lifestyle changes to support clear thinking and prevent decline.
This is a critical window of time to recognize challenges and to make changes that can significantly improve your health, happiness, and quality of life as well as your future.
Lifestyle interventions to manage or treat mild cognitive impairment
Healthy lifestyle interventions can help improve cognitive function, quality of life and prevent further decline or progression of mild cognitive impairment.
Making healthy choices can promote overall wellness and make an impact on your cognitive function now and in the future.
Lifestyle interventions may include:
- Regular physical exercise which can combat mental fatigue, reduce stress, improve cognition, and protect against dementia.
- Eating a diet rich in fruits and vegetables that can promote heart health and protect your brain.
- Developing effective memory strategies to support strong recall, as early as possible.
- Optimizing sleep routines and stress management.
- Building better brain health habits.
Within the Memory Confidence Method™ program, we focus on mastering memory strategies to support clear recall, fueling brain health to optimize cognition and resilience and building sustainable habits to create lasting change. Making these changes can feel overwhelming if you’re at it alone. I’m here to help you! If you’re ready to make these changes and you need support, click here to schedule a free call with me to discuss how I can help.
Living with Mild Cognitive Impairment
You can live a full, happy, and independent life with mild cognitive impairment. As stated above, in some cases MCI can be resolved, while in others it may stay the same and never progress to dementia.
Focusing on your strengths, addressing your weaknesses, and prioritizing your happiness can help you maintain a positive mindset.
If you or someone you love needs help navigating changes to their memory and thinking, I’d love to support you. You can use this link to schedule a free call with me to discuss how the Memory Confidence Method™ program can help.
*Information in this article is not intended to be medical advice.