Mild Cognitive Impairment (MCI)

Mild Cognitive Impairment (MCI) is characterized by memory loss which has still not significantly affected daily functioning of a person. Memory loss may be minimal to mild and not easily noticeable to the individual yet. It is a transitional period between the expected deterioration of cognitive abilities of normal aging and the more obvious decline of dementia. A person with MCI may know that his memory or mental function has slipped and some changes may be noticeable but not severe enough to disrupt everyday activities or functions.

Mild cognitive impairment is said to be a precursor to dementia or Alzheimer’s disease, which is the most common type of dementia, as it increases the risk of dementia especially if the main difficulty of the person is with memory. This is not to say, however, that a person with MCI will get worse no matter what. There are some people with MCI, who never get worse or develop dementia and some of them may actually get better eventually.

Symptoms

The brain undergoes some changes as a person grows older like the rest of the body. Most aging people become too forgetful or it may take a longer time to think of a word or remember a person’s name.

Cognitive problems may go beyond what is expected and may indicate possible MCI if a person experience the following symptoms:

• Frequent forgetfulness of things
• Forgetfulness of events like appointments or social events
• Getting lost in the middle of a conversation, or a book, or a movie
• Feeling overwhelmed with decision making, planning steps to accomplish a task or following instructions
• Having trouble remembering ways around familiar places
• Showing signs of impulsivity or increasing poor judgment
• Family and friends of the person are aware of these changes

A person with MCI may also experience depression, aggression and irritability, apathy, and anxiety.

Classic examples of symptoms observed in people with MCI are being unable to recall the names of people they already know or met recently; trouble keeping track of the flow of a conversation, and frequent misplacing of things. In most cases, the person is quite aware of these problems and tries to compensate the difficulty by using notes and calendars as reminders.

These problems are similar on a milder level to the neuropsychological findings associated with Alzheimer’s disease or other dementias. In some cases, the patient may have mild difficulties performing daily activities.

Diagnosis

The doctors conduct a clinical evaluation that may lead to the diagnosis of MCI as the likely cause of the symptoms observed in a person as there is no specific test to confirm such diagnosis. The doctor’s medical evaluation include extensive investigation of the memory loss problems like details on what was forgotten, when it happened, and how long has it been happening. The doctor also orders imaging and lab tests and if necessary psychological tests to rule in or out MCI diagnosis and explores if other cognitive problems are present or occurring like organization and planning problems, visuospatial abilities, etc.

Most doctors diagnose MCI based on the following criteria determined and developed by a panel of international experts:

• You have memory problems or another mental function, such as planning, following instructions or making decisions. Aware of the problems, you affirm by checking with someone close to you.

• Some of your abilities and capabilities have dramatically declined over time. Your medical history reveals that your performance and thinking abilities have declined from a higher level. Again, this change will be confirmed by someone close to you.

• Your overall mental function and daily activities are not affected despite these changes. In a general sense, your overall abilities and daily activities are not impaired, although there may be specific symptoms that can cause worry and inconvenience.

• Testing of mental status will show a mild level of impairment based on your age and education level. Doctors usually assess mental performance with the Mini-Mental State Examination (MMSE) test. If necessary, more detailed neuropsychological testing may be conducted to understand how severe memory impairment is, if other mental abilities are affected and which types of memory are seriously affected.

• Your findings do not meet criteria for dementia. The doctor evaluated that the memory problems complained about which are also documented through corroborating reports, your medical history or mental status testing are not severe enough to make a diagnosis of Alzheimer’s disease or another type of dementia.

The doctor may conduct other neuropsychological tests to help in determining the degree of memory impairment.

• Neurological exam

The neurological exam includes basic tests that will indicate the coordination level of your brain and nervous system –spontaneous response, eye movements, gait and balance, and the sensory ability. These tests can also help detect any indication of Parkinson’s disease, or other medical conditions like strokes or tumors that can affect memory and physical functions, as well.

• Laboratory tests

Laboratory blood analysis may be required to help rule out specific problems that affect memory such as deficiency in Vitamin B12, folate, vascular inflammation, systemic lupus, rhematoid arthritis, sarcoidosis, HIV infection, syphilis, lyme disease, or thyroid problems.

• Brain imaging

If necessary, MRI or CT scan of head may be ordered by the doctor to check for the presence of other brain-associated problems such as tumors.

Treatment

There are not any the Food and Drug Administration (FDA) approved drugs or treatment for MCI. But MCI is an active area of research and clinical studies aimed at shedding more information and valid explanation on the disorder to find treatments that may help improve the symptoms or prevent or delay progression to dementia.

• Alzheimer’s drugs

Cholinesterase inhibitors or NMDA inhibitors (memantine), FDA approved drugs for Alzheimer’s disease are sometimes prescribed for people with MCI if the main symptom observed is memory loss. However, these drugs aren’t advised for routine use in MCI for their short-term benefit.

• Treating other conditions that can affect mental function

MCI is not the only condition causing memory loss. There are other medical conditions that can be attributed for a person’s forgetfulness. Diagnosis and treatment of such medical problems can help enhance memory and mental functioning. These conditions that commonly contribute to memory loss include:

• High blood pressure. MCI usually links problems with the blood arteries inside the brain. Memory difficulties may be aggravated by hypertension. Monitoring of blood pressure is necessary and interventions or treatment to lower it are recommended if it’s above normal limit, usually 140/80 mmHg.
• Depression. Depressed people often become forgetful and mentally “foggy.” This condition is common in people with MCI, too. Treatment of depression is essential to minimize memory loss problems and even may eliminate all memory problems. Hence another name for depression is “pseudodementia.”
• Sleep apnea. This condition, in which breathing stops and starts repeatedly while asleep can make a person feel excessively tired during the day. It will also cause forgetfulness and inability to concentrate. Treating sleep apnea can improve sleeping habits of the person and consequently improve MCI symptoms and restore alertness.