Mild Cognitive Impairment (MCI): Learn how to identify it

“My mind isn’t as sharp as it once was,” mutters the elderly man in conversation. Forgetting a name or date is hardly a cause for concern. Memory loss is common with age. But what specifies age-related deficits in thinking from a more serious condition? Mild cognitive impairment is a term describing a decline in cognitive skills greater than expected for the person’s age. Recognizing the signs is important, as MCI increases the risk of Alzheimer’s and other forms of dementia.

Mild Cognitive Impairment
Mild Cognitive Impairment

What is Mild Cognitive Impairment?

Cognitive impairment refers to problems with memory, concentration, learning new information, planning, organization, and decision making. Mild cognitive impairment impacts those specific skills. It is the stage between normal, expected signs of aging and the marked cognitive decline of dementia. Someone with mild cognitive impairment has more cognitive and memory problems than normal for their age, but not significant enough to warrant a dementia diagnosis. The cognitive decline associated with mild cognitive impairment does not hugely impair day-to-day function. Friends and family notice slight changes, yet the cognitive deficits are easily mistaken for aging.  

The Alzheimer’s Association estimates that 15 to 20 percent of people 65 years or older have mild cognitive impairment. While the condition does not progress for some, one-third of the population diagnosed with mild cognitive impairment will eventually develop dementia.

Symptoms of Mild Cognitive Impairment

Medical professionals categorize mild cognitive impairment by the thinking skills affected. Each presents with separate symptoms.

Amnestic Mild Cognitive Impairment

Amnestic MCI mainly affects memory. It affects both short-term and long-term memory. People with the condition have trouble recalling names, recent events, and dates. They struggle to remember how to complete familiar tasks, as well as recognizing locations.

Non-amnestic Mild Cognitive Impairment

Non-amnestic MCI affects the cognitive skills that do not pertain to memory. This includes judgment, attention, completing tasks, and visual perception. Signs of non-amnestic are the following:  

  • Difficulty with planning and organization
  • Acting impulsive and showing poor judgment
  • Cannot follow instructions to complete tasks  
  • Depression
  • Anxiety
  • Mood changes like aggression and irritability
  • Trouble with conversation
  • Getting lost while traveling to familiar places
  • Problems with paying attention

Causes of Mild Cognitive Impairment

The cause of it is unknown. The current hypothesis is that the condition results from any factors that induce brain changes outside of the normal aging process.

Neurodegenerative Conditions

Researchers conclude that of MCI manifests from the same brain changes of neurodegenerative conditions like Alzheimer’s disease, Parkinson’s disease, and Lewy body dementia. However, the features are less advanced in mild cognitive impairment.

Alzheimer’s Disease

The main brain features of Alzheimer’s disease resembles the characteristics of MCI. Alzheimer’s disease is a form of dementia that damages the brain’s nerve cells. It is characterized by two abnormal structures: plaques and tangles. Plaques are deposits of beta-amyloid—a protein normally broken down in a healthy brain. Alzheimer’s disease prevents the brain from eradicating these plaques, and they build up in the spaces between nerve cells. Tangles involve twisted fibers of tau, which is another protein that inappropriately builds up within brain cells. A number of those with mild cognitive impairment show plaques and tangles like Alzheimer’s patients.

Parkinson’s Disease

When associated with Parkinson’s disease, MCI is called Parkinson’s disease mild cognitive impairment. The cognitive decline stems from the decrease in brain chemicals like dopamine, norepinephrine, and acetylcholine.

. The cognitive decline stems from the decrease in brain chemicals like dopamine, norepinephrine, and acetylcholine.

Lewy Body Dementia

Lewy body dementia is the second most prevalent dementia after Alzheimer’s disease. Lewy bodies are abnormal deposits of alpha-synuclein—a protein found at the tips of nerve cells in the brain. In Lewy body dementia, Lewy bodies accumulate in areas of the brain responsible for memory, movement, and thinking. A subset of patients report similar pathologies.

Disrupted Blood Flow to the Brain

Proper cerebral blood flow is needed for healthy brain function. If the brain is not receiving sufficient blood flow, it is deprived of oxygen. Chronic hypoxia damages brain cells, which provokes the memory loss and cognitive symptoms associated with mild cognitive impairment.

Conditions that reduce blood flow to the brain are a stroke, traumatic brain injuries, tumors, blood clots, and hydrocephalus—excess fluid in the brain. Enlarged ventricles from fluid build-up, as well as shrinkage within the brain, are regular findings.

Medication Induced Mild Cognitive Impairment

Certain drugs can cause cognitive symptoms such as memory loss, drowsiness, inattention, delirium, and hallucinations. Medications have the potential to cause mild cognitive impairment and even lead to dementia.

Drugs that frequently cause it are benzodiazepines prescribed for anxiety, anticholinergics, anticonvulsants, antihistamines, narcotics, steroids, and chemotherapy agents. There is particular emphasis on anticholinergics as a cause of it because this class of medications blocks the action of acetylcholine by binding to its receptors in the central nervous system.

Studies in the Journal of Drugs & Aging confirms the elderly suffer the cognitive effects of medications more than younger patients due to differing rates of metabolism (1999). Depending on the situation, drug-induced mild cognitive impairment is sometimes reversed by discontinuing the medication.

Other Bodily Stressors

It is caused by a variety of bodily stressors. These include:

  • Depression, stress, and anxiety
  • Sleep disorders (i.e. insomnia, apnea)
  • Drug or alcohol abuse
  • Thyroid, kidney, or liver problems
  • Heart disease
  • Diabetes
  • Vitamin deficiencies (i.e. B12, D, etc.)
  • Hearing loss
  • An infection
  • Obesity

Risk Factors for Mild Cognitive Impairment

Aside from the above factors which professionals speculate to cause of mild cognitive impairment, there are risk factors for developing the condition:

  • Being 65 years of age or older
  • Having a family member with mild cognitive impairment or dementia like Alzheimer’s disease
  • Having a mutation in the APOE-e4 gene linked to Alzheimer’s disease
  • Substance abuse
  • Lack of exercise
  • Having a medical condition (i.e. diabetes, stroke, high cholesterol, heart disease, etc.)

Progression of Mild Cognitive Impairment

Having it does not mean the patient will develop dementia. The progression depends on the individual. In patients 65 years or older, 20 percent will develop dementia by the third year. Remaining studies reflect that 15 to 40 percent of patients experience improvement in their symptoms or return to a normal mental state entirely (Ritchie, 2001). Predicting the progression of dementia in MCI is not within the current scientific ability.

Diagnosing Mild Cognitive Impairment

The patient suspected to have it must meet a strict set of criteria:

  1. Concern about a change in cognition: The diagnosing physician requires there be evidence of concern over changes in cognition in comparison to the patient’s previous level.
  2. Impairment in one or more cognitive domains: Cognition is impaired greater than expected for the patient’s age. The domains include memory, executive function, attention, language, and visuospatial skills.
  3. Preservation of independence and functional abilities: Those with mild cognitive impairment generally maintain their independence. Tasks like paying bills, engaging in deep conversation, cooking, and self-care take more time and are not as efficient, but their level of impairment requires minimal assistance.
  4. Not demented: Demented is in reference to dementia—a severe decline in mental function that interferes with daily life. To meet the criteria for MCI, the patient cannot exhibit significant social and cognitive dysfunction. Multiple evaluations might be of benefit to assess the amount of cognitive decline from the patient’s baseline. Physician’s cannot establish proof of a decline if they have only seen the patient once.

Psychoneurological Exam

After the initial assessment of the criterion, a doctor performs a psychoneurological exam which tests walking, balance, coordination, reflexes, and eye movements. The goal of the neurological examination is to ascertain how the brain and nervous system are working. A positive neurological exam indicates medical conditions that impair memory and physical function like a tumor, a stroke, or Parkinson’s disease. The physician then moves on to mental status testing as part of the evaluation. They ask questions the patient should know the answer to such as today’s date, their birthday, or the details of current events.

Imaging and Labwork

Imaging studies cannot diagnose mild cognitive impairment, but CT and MRI scans look at the brain to find dementia-specific brain changes and to rule out other conditions that cause cognitive symptoms. Simple bloodwork also rules out vitamin deficiencies or thyroid problems.

Treating Mild Cognitive Impairment

Treatment for MCI is just as limited as the diagnostic studies used to diagnose the condition. There are no medications approved by the Food and Drug Administration (FDA) for mild cognitive impairment. Treatment focuses on lifestyle adjustments and therapy.

Cholinesterase Inhibitors

Cholinesterase inhibitors are a class of medications that block the breakdown of acetylcholine. They are beneficial in the beginning stages of Alzheimer’s disease, as acetylcholine is an important neurotransmitter for memory. Cholinesterase inhibitors are effective because the nervous system has more acetylcholine is available to communicate between brain cells. Although not designed for MCI, physicians prescribe cholinesterase inhibitors in these patients for their modest improvement in cognitive function.

Medications for Mild Cognitive Impairment
Medications for Mild Cognitive Impairment

Treating Other Conditions

While it cannot be treated directly, underlying health conditions that exacerbate cognitive symptom can be! The first step is identifying what conditions are contributing. For example:

  • Medications to lower blood pressure treats heart disease.
  • C-PAP equipment combats sleep apnea by forcing air into the lungs while sleeping.
  • Depression and anxiety are both responsive to antidepressant medications or psychotherapy.
  • Supplementation counteract vitamin deficiencies.
  • Exercise and diet can resolve obesity.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy is a type of psychotherapy based on the idea that false assumptions, thoughts, and perceptions drive human action. The therapist practicing cognitive behavioral therapy identifies unproductive thought processes and implements coping strategies to alter behavior. Cognitive-behavioral therapy is still in the research phase, but it is quickly becoming a first-line approach. A study published by JAMA Neurology confirmed an 88% reduction of cognitive decline amongst a trial group of 221 African American patients with MCI (Rovner, 2018). For patients with MCI and dementia, cognitive behavioral therapy is best implemented to treat depression and anxiety secondary to their condition.

Healthy Lifestyle

Healthy lifestyle modifications have a positive impact on brain health. Regular exercise is conducive to the memory problems of mild cognitive impairment, as the brain releases healing endorphins and dopamine during physical activity. Experts recommend exercises such as walking or aerobics for 30 minutes daily 4 times a week. Along with exercise, dietary measures also protect brain health. Consume a diet rich in vitamins, minerals, and antioxidants. Examples are berries and other fruits, plus green, leafy vegetables. Nuts, fish, and brussel sprouts are sources of omega-3-fatty acids which support the membrane of brain cells to strengthen the communication of the nervous system.

Supporting A Loved One with Mild Cognitive Impairment

Recognizing a cognitive decline with little control of the outcome is incredibly disconcerting. Those with MCI are prone to depression and anxiety from stress. A strong support system is imperative to cope with the condition. If you have a loved one who suffers from MCI, there are ways to encourage them throughout their health journey.

Attend Medical Appointments

Going to medical appointments alone is stressful for someone with mild cognitive impairment. Not only do they worry about what the appointment will entail, but they also are preoccupied with remembering the details. They might struggle to recall the location of the office or information from their doctor. These concerns drastically diminish the quality of the appointment. Having a loved one at the appointment relieves that burden, as they are assured the person attending with them will have the information they could have missed.

Find a Support Group

MCI can be just as overwhelming for friends and family as it is for the patient. So, finding a support group is beneficial for mental health. It provides the opportunity to bond with caregivers, family, and friends of other patients and shows your loved one with mild cognitive impairment of the willingness to support them. At support groups, you share your worries and learn tips for strengthening your relationships.

Organize Their Home

Planning and organization are skills affected by mild cognitive impairment. With the condition, household chores fall to the wayside. Bills, cooking, and laundry are no longer done with ease. Whether struggling to find items to accomplish chores, forgetting to turn off the stove, or losing track of their checkbook, MCI patients need minor assistance in these areas. Organizing their home or simply being present bolsters their confidence that they can partake in tasks without endangering themselves or others.

Offer Transportation

Driving is another skill that deteriorates with some patients diagnosed with mild cognitive impairment. However, the patients themselves probably won’t realize the changes. By offering transportation, friends and family can evaluation driving skills and intervene if necessary.

Include Them in Social Activities

A diagnosis of mild cognitive impairment does not distract from the desire to be included. Managing an active social life is central to preserving cognitive abilities. Invite them to participate in gatherings, parties, or games. Recently, a study by the Mayo Clinic determined that “cognitively normal individuals 70 years or older who engaged in craft activities, social activities, computers, and games, significantly decreased their risk of MCI” (2017). With a favorable response from healthy controls, the study that much more useful in emphasizing the benefits of social activities for mild cognitive impairment.

10 Tips on How to Prevent and Slow Mild Cognitive Impairment

As there is currently no cure for MCI, it is imperative that we take precautions for a future onset. Training your brain daily will be the best shield against mild cognitive impairment.

1- Perform daily brain training

The Nature Magazine and a multitude of studies show the importance of brain training in order to help prevent cognitive impairment.

Valencia et al. (2008) have demonstrated the positive effects of brain training programs, either general or specific memory training, in cognitive impairment.

CogniFit is the leading program in cognitive assessment and brain training. CogniFit offers specific brain training for mild cognitive impairment and for people 55 and over.

CogniFit Brain Training
CogniFit Brain Training: Trains and strengthens essential cognitive abilities in an optimal and professional way.

CogniFit cognitive stimulation is the most widely used non-pharmacological treatment for it and early dementia. CogniFit technology is standardized and validated by the scientific community. It focuses on neuroplasticity. This brain capacity allows the evolution of the disease to slow down, and preserve, for longer, the cognitive abilities of the person, improving their quality of life.

CogniFit battery of exercises allows you to accurately assess and measure any person’s cognitive strengths and weaknesses. CogniFit will display a graph with the cognitive results and will automatically generate a personalized training that best suits the cognitive needs of each person.

2- Try the Mediterranean diet

Studies show that a high consumption of monounsaturated fatty acids (olive oil) and a low consumption of saturated fatty acids can have a protective effect against cognitive disorders, and against mild cognitive impairment in particular.

In addition, eating fish and shellfish once a week can significantly reduce the onset of cognitive impairment, according to a study published by the University of Chicago.

This rate of reduction would range between 10% and 13%, being beneficial for those who eat oily fish, rich in omega 3 and shellfish, compared to the population that hardly ever does. Food for the brain, and vitamins for the brain.

3- Use mnemonic memory

These kinds of strategies will help your memory retain recent information. Specifically, data categorization has very beneficial effects on people with mild cognitive impairment, and consists of giving specific instructions to repeat and remember information topics by categories.

It is very helpful to remember key words and repeat information.

Example: The person with mild cognitive impairment will more easily remember the medication they must take if they groups these medications into categories to activate recall.

4- Use visual aids

It has been shown that older people remember images more than words. It is important to provide visual memory content, such as, lists, notebooks, post-its, calendars, agendas, reminders in places that are very frequented (the fridge, television, the mirror,etc.) will be a very useful tool.

5- Walk 30 minutes a day

When we do moderate physical exercise, the brain cells are provided with sufficient oxygen, being a very favorable aspect in delaying the appearance of mild cognitive impairment.

Physical activity improves attention, memory, verbal fluency, global cognitive status and processing speed, skills that suffer most when mild cognitive impairment is diagnosed. It also helps to maintain the white and grey substance, especially of the parietal lobe.

6- Avoids tiredness and fatigue

It has been shown that older people process new information more slowly, especially in stressful situations where they have to multitask.

R.S. Wilson of Rush University Medical Center in Chicago says that continued anxiety alters cognitive functioning and accelerates the risk of dementia. So we have to take care of that aspect. How do we do that? Studies with seniors showed better cognitive functioning in those with more stress management skills or who regularly practiced meditation, relaxation, or yoga.

7- Never stop reading

The reading habit is a protective factor of cognitive impairment, and this protection is most significant in those frequent readers whose reading history exceeds 5 years. Encouraging reading could be a good primary prevention strategy for the population (Collado and Esteve 2012).

Read everything that falls into your hands; the newspaper, a magazine, books that you had pending, etc. gives your brain the best shield it can have to stop mild cognitive impairment.

8- Give more importance to your social relationships

Loneliness and isolation are factors associated with increased cognitive impairment. When the person with MCI becomes aware of it and suffers from memory loss, they tend to isolate themselves, try to motivate them not to.

Help them participate in social activities (meetings, social centers, etc.) or collaborate with ONGs or volunteer causes.

9- Choose a hobby and set it in motion

One of the good things about old age or “Golden Age” is the wonderful amount of time you have when retired. It’s the perfect time to dare to do what you’ve always wanted to do but with the excuse of time you never started. Create a garden, sign up for painting classes, etc.

mild cognitive impairment
Mild cognitive impairment

Practicing a hobby regularly helps and promotes the correct performance of cognitive skills, and it is an excellent way to avoid cognitive impairments. Hobbies can delay the onset of mild cognitive impairment in over 65 years.

10- Ask for help when you notice the first symptoms

If you think you may be suffering from memory loss, don’t hesitate to see a specialist.

Early detection of mild cognitive impairment can help you slow down and change your life, include routines and exercises such as those presented in this article to improve your quality of life and slow the progression of cognitive impairment.

Above all, don’t isolate yourself or avoid family members who want to help you. If discovered early, mild cognitive impairment may not progress to other, more damaging stages of dementia.

As always, prevention and early detection of cognitive decline is fundamental.

References

Moore, A.R.; O’Keeffe, S.T. Drug-induced cognitive impairment in the elderly. Drugs Aging 1999, 15, 15–28.

Krell-Roesch J, Vemuri P, Pink A, et al. Association Between Mentally Stimulating Activities in Late Life and the Outcome of Incident Mild Cognitive Impairment, With an Analysis of the APOE ε4 Genotype. JAMA Neurol. 2017;74(3):332–338. doi:10.1001/jamaneurol.2016.3822

Ritchie K, Artero S, Touchon J. Classification criteria for mild cognitive impairment: a population-based validation study. Neurology 2001; 56:37–42.

Rovner BW, Casten RJ, Hegel MT, Leiby B. Preventing Cognitive Decline in Black Individuals With Mild Cognitive Impairment: A Randomized Clinical Trial. JAMA Neurol. 2018;75(12):1487–1493. doi:10.1001/jamaneurol.2018.2513