Mild cognitive impairment: What you need to know

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We’ve all walked into a room, only to have forgotten exactly why we are there. Or maybe our ability to recall names of long-lost friends or classmates isn’t quite what it used to be.

These are normal signs of aging. But, if such events begin to happen more frequently or escalate, then it could be something called mild cognitive impairment, often called MCI.

Mild cognitive impairment is an early stage of memory—or cognitive ability—loss in people who can still independently perform most daily activities.

If mild cognitive impairment is not a familiar term to you, you aren’t alone.

A recent survey from the Alzheimer’s Association found that 82% of Americans are unaware of the condition or know little about it. And yet it affects about 10 million people in the United States.

For people diagnosed with mild cognitive impairment, within just one year 10 to 15% of them will go on to develop dementia, a general term for loss of memory and other mental abilities that is severe enough to interfere with daily life.

And one-third of those with MCI will develop Alzheimer’s (the most common form of dementia) within five years.

Seeking medical attention for signs of MCI is important because it may be caused by something that can easily be reversed, such as a medication or a medical condition, says Carolyn Fredericks, MD, a Yale Medicine neurologist.

Yet, according to the Alzheimer’s Association survey, just 40% of respondents said they would see a doctor if they experienced MCI symptoms.

This is unfortunate, Dr. Fredericks says, because whether it’s a condition that can be fixed or not, there are clinical trials patients can enroll in that might offer treatment options they wouldn’t otherwise have.

We talked more with Dr. Fredericks about the distinctions between “normal” aging, MCI, and dementia, and what, if any, steps can be taken to prevent cognitive decline.

Mild cognitive impairment vs. normal aging

Normal aging and mild cognitive impairment are definitely distinct from one another, Dr. Fredericks says.

“Basically, mild cognitive impairment is when someone has clear symptoms showing changes in their memory or their thinking, but the changes don’t affect their ability to do their day-to-day activities,” she says. “That is what distinguishes it from dementia.”

With MCI, the changes are often noticed by friends and family members, too.

It’s also something that can be seen on a neuropsychological evaluation, which measures how well your brain is working by testing reading, language usage, learning, processing speed, reasoning, and problem-solving, as well as mood and personality.

Much of what differentiates MCI from normal aging has to do with how often someone struggles with memory or cognition.

What, then, is normal aging? Do memory and cognition naturally decline in everyone as we age? Like many of the great questions of the brain, there isn’t a clear answer, Dr. Fredericks says.

“But the larger studies generally show that people can be expected to do their best on certain tests of memory and thinking in their 20s or so, and that it’s pretty normal for all of us to not be as good at memorizing a list of words [as we age], even starting in our 30s.”

“But some things—like vocabulary—can actually improve as people get older if they keep reading and stay active,” Dr. Fredericks says.

Still, that doesn’t mean everyone loses sharpness as they age. “There’s a category of individuals called super-agers in which people who are in late life—80s, 90s—are scoring as well or better than the average person would be much earlier in life,” Dr. Fredericks says.

Diagnosing mild cognitive impairment

If you have concerns about your memory or cognition, talking to your primary care physician is a good place to start.

Your medical provider will also likely ask to talk to family members to hear their concerns and get a better perspective of what changes may be going on.

If you decide to see a specialist, you might be referred to a behavioral neurologist or a neuropsychiatrist, both of whom specialize in treating memory and cognitive concerns.

If a diagnosis of MCI is suspected, your specialist will likely recommend brain imaging, such as an MRI (magnetic resonance imaging), to rule out lesions or strokes.

If these issues aren’t seen but the MRI shows patterns more consistent with Alzheimer’s, it is good for patients to know; they may have a chance to participate in clinical trials, Dr. Fredericks points out.

The Alzheimer’s Disease Research Unit at Yale offers treatment, neuroimaging, and genetic studies of Alzheimer’s disease.

There are a number of trials and therapies open to people with early symptoms or those who have strong family histories of the condition.

Another good reason to know if you have MCI or some form of dementia is that it may give you a push to get other aspects of your life in better order, Dr. Fredericks says.

Preventing more cognitive decline

If you are diagnosed with MCI, is there anything you can do to prevent further cognitive decline?

While there is no specific treatment for MCI, there is evidence that following a healthy diet, for anyone, can help, Dr. Fredericks says.

Specifically, Dr. Fredericks points to research about the so-called Mediterranean diet, which emphasizes whole grains, seafood, and nuts, and the DASH (Dietary Approaches to Stop Hypertension) diet, which is designed to help lower or control high blood pressure.

Furthermore, staying cognitively active—especially after retirement—is key, she adds.

Plus, combining any mental activity with a social component is a good idea, she explains. “Instead of just reading a book, join a book club and discuss it with people, which forces you to really engage with the material,” Dr. Fredericks says.

“I have patients who sing in a choir, which is a wonderful social and cognitive activity because there’s so much going on in your brain when you’re coordinating with others and with the music. You’re surrounded by a group of people that you’re close with, too.”

Written by Carrie MacMillan.

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