Mild Cognitive Impairment (MCI): A Beginner's Guide

Quick summary

Noticeable memory loss doesn't always mean Alzheimer's disease. All adults forget names, lose keys, and can't remember what they walked into a room to retrieve. Although many people reach their 80s and 90s with sharp minds, some forgetfulness is considered a normal side effect of busy, stressed lives and aging bodies.

But there's a degree of the problem that's more serious -- though not severe enough to be defined as dementia. It's a subtle decline in mental ability known as mild cognitive impairment (MCI).

A person with MCI can have noticeable trouble with language (including speaking, reading, and writing), reasoning, judgment, and memory. But generally they can manage their daily affairs independently and may not even seem impaired to those who don't know them well. According to the Mayo Clinic, 12 percent of those over age 70 have MCI.

What is MCI?

There are two types of mild cognitive impairment:

• Amnestic MCI, which significantly affects memory as well as other cognitive functions. People with this type of cognitive impairment are three to four times more likely to develop Alzheimer's than someone without MCI.
• Non-amnestic MCI, which affects cognitive functions other than memory. This form of MCI is more often linked with non-Alzheimer's dementia, such as frontotemporal dementia or dementia caused by Lewy bodies.

The root of MCI isn't completely known. Possible causes include:

• A neurodegenerative disease, such as what could become Alzheimer's
• A vascular condition, such as what could become vascular dementia
• A psychiatric condition, such as depression
• An injury, such as brain trauma

When should I worry?

Not everyone with MCI goes on to develop dementia. However, since early diagnosis of Alzheimer's and other forms of dementia can help a family make better long-term plans and possibly delay the progression of symptoms, it's smart to take action when you first suspect a memory problem or notice behavioral changes in your parent.

Some possible signs of MCI:

• Your parent begins forgetting appointments or regularly scheduled events (Sunday dinner with you, a weekly club meeting)
• Your parent increasingly repeats questions or stories
• Your parent starts asking you more questions about managing finances (a cognitively challenging task)
• Your parent occasionally forgets to take medications
• Your parent, although still capable, shows less interest in cooking (it's just getting too complicated)

All of these are subtle changes that may or may not be warning signs, but they present reasonable red flags that warrant a medical exam. (Basic, well-rehearsed daily tasks like bathing and grooming tend to be less affected. By the time you notice problems in this area, actual dementia is more likely.)

How do I get my parent checked out?

Try a straightforward approach: "Mom, have you noticed having trouble remembering things recently? It seems like you've been forgetting to do things lately. There are a lot of different reasons memory can be affected, so why don't you mention this to your doctor so he can see if there's anything you can do about it. It might be nothing, but then again there might be a simple explanation or remedy."

If you already accompany your parent to medical appointments, mention what you've noticed to your parent's doctor and ask if she can be screened for MCI.

Be sure that your parent gets a complete medical workup. Simply mentioning memory loss to a physician and walking out of the appointment with a prescription for Aricept isn't good medicine in action. A proper exam should involve an extensive interview, memory tests, and lab tests to rule out other ailments. It's ideal if you, your other parent, or a sibling is at the exam to provide input, as your parent may not be fully aware of changes.

What can we do if it is MCI?

There aren't yet any treatments, including any FDA-approved medications, for MCI. There's some evidence that donepezil (Aricept) can slow the progression of MCI to Alzheimer's disease in people with amnestic MCI in the short term.

If your parent is indeed found to have MCI but not Alzheimer's or another form of dementia, her abilities may not decline any further. But at least you have the advantage of having had a distant early warning so that you (and your parent's physician) can monitor your parent's behavior and make appropriate plans in the event of further decline.

Your parent can also take steps to cope with memory problems. Depression is often found in people with MCI, although it's unclear whether the depression causes the cognitive decline or the other way around. Treatment for depression may help your parent cope with the changes she'll be facing.