Mild Cognitive Impairment

What is mild cognitive impairment?

Mild cognitive impairment (MCI) happens when you experience a slight — but noticeable — decline in mental abilities compared to others your age. Mental abilities include:

• Memory.
• Reasoning and judgment.
• Planning and completing complex tasks.

You may notice the decline in your abilities, or a loved one might. But the changes aren’t severe enough to interfere with daily, routine activities of life.

What’s the difference between mild cognitive impairment and mental decline due to aging?

It’s natural and expected to have some gradual mental decline as you age. For example, learning new information may take longer than before. Or your speed of performance may get slower.

But these declines due to aging don’t affect your overall functioning or ability to perform daily activities. Normal aging doesn’t affect recognition, intelligence or long-term memory.

As you age beyond 65 years, you may occasionally forget names and words and misplace things. With mild cognitive impairment, you frequently forget conversations and information that you would typically remember, like appointments and other planned events. MCI interferes with your daily, routine activities.

What’s the difference between dementia and mild cognitive impairment?

Both dementia and MCI are descriptive terms that tell us about the degree of cognitive change and how it affects daily activities. The main difference between MCI and dementia is that the mental decline in MCI doesn’t interfere with daily living, whereas dementia does. In addition, people with MCI don’t experience personality changes that people with dementia can. Many underlying conditions can lead to MCI or dementia.

Dementia involves a decline in mental function from a previously higher level that’s severe enough to interfere with daily living. A person with dementia has two or more of these specific difficulties, including a decline in:

• Memory.
• Reasoning.
• Language.
• Coordination.
• Mood.
• Behavior.

Does MCI always lead to dementia?

Some people with MCI eventually develop dementia, but others don’t. For certain neurodegenerative conditions, MCI can be an early stage of the condition. Neurodegenerative conditions affect your brain and get worse over time. Alzheimer’s disease and Parkinson’s disease are examples of this. Some people with MCI return to normal cognition for their age or remain stable.

How common is mild cognitive impairment?

The American Academy of Neurology estimates that mild cognitive impairment is present in the following populations:

• 8% of people aged 65 to 69.
• 15% of people aged 75 to 79.
• 25% of people aged 80 to 84.
• 37% of people 85 or older.

What are the symptoms of mild cognitive impairment?

The main sign of mild cognitive impairment is a slight decline in mental abilities. Examples include:

• Memory loss: You may forget recent events or repeat the same questions and stories. You may occasionally forget the names of friends and family members or forget appointments or planned events. You may also misplace items more often than usual.
• Language issues: You may have difficulty coming up with the right words. You may also have trouble understanding written or verbal information as well as you used to.
• Attention: You may lose focus or get distracted more easily than you used to.
• Reasoning and judgment: You may have difficulty problem-solving and making decisions.
• Complex planning: It may be more difficult to plan and/or complete complex tasks, like paying bills, taking medications, shopping, cooking, household cleaning and driving.

Movement difficulties and problems with your sense of smell are also linked to MCI.

What causes mild cognitive impairment?

Mild cognitive impairment can have several possible causes. Some are treatable and others aren’t.

Some of the possible causes include:

• Depression, chronic stress and anxiety.
• Thyroid, kidney or liver problems.
• Sleep apnea and other sleep disorders.
• Conditions that affect blood flow in your brain, like tumors, blood clots, stroke or traumatic brain injury.
• Vitamin B12 deficiency or other nutrient deficiencies.
• An infection, such as a urinary tract infection (UTI).
• Side effects of certain prescription medications, like calcium channel blockers, anticholinergic drugs, benzodiazepines and others.
• Substance use disorder and alcohol use disorder.

MCI is often an early stage of certain neurodegenerative conditions. MCI can be an early stage of:

• Alzheimer’s disease.
• Parkinson’s disease.
• Lewy body dementia.
• Vascular dementia.
• Frontotemporal dementia.

What are the risk factors for mild cognitive impairment?

The strongest risk factors for mild cognitive impairment are the same as those for dementia:

• Being 65 or older.
• Having a biological family history of dementia.
• Having conditions that increase your risk of cardiovascular disease, including high blood pressure, high cholesterol levels, diabetes and obesity.

How is mild cognitive impairment diagnosed?

Confirming a diagnosis of mild cognitive impairment can be difficult. Many conditions involve MCI as an early sign. And some of its symptoms are common to many other illnesses.

Your healthcare provider will:

• Ask about your symptoms.
• Ask about your medical history.
• Review your current medications.
• Ask about your biological family history of significant memory problems or dementia.
• Perform a physical exam and mental status exam.
• Get input from a family member or trusted friend on how your mental functions may have changed.

They may also order the following tests:

• Laboratory tests: Your provider may order blood or urine tests to look for signs of infection or inflammation. They may also check your thyroid hormone levels and if you have a vitamin B12 deficiency. Sometimes, providers order cerebrospinal fluid tests (spinal tap) to check for autoimmune conditions and neurodegenerative diseases.
• Imaging tests: Computed tomography (CT) and magnetic resonance imaging (MRI) tests look for evidence of brain damage, such as stroke, bleeding, tumors and fluid on your brain.
• Neuropsychological tests: These are a series of verbal and written tests that gauge your mental abilities, like general intellect, language usage, memory, learning and more.

Neurologists and healthcare providers who specialize in treating people 65 and older (geriatricians) may assist in making the diagnosis of mild cognitive decline.

How is mild cognitive impairment treated?

The treatment for MCI depends on the underlying cause if known. However, some cases of MCI from neurodegenerative diseases can’t be reversed. But if your mental changes are due to causes like an infection, sleep problems, mood or medication side effects, your healthcare provider will come up with a treatment plan.

The U.S. Food and Drug Administration (FDA) hasn’t currently approved any medications to directly treat mild cognitive impairment. But there are treatment plans that include nonmedication options to improve cognition. They vary based on the underlying cause of MCI. Researchers are hopeful that Alzheimer’s disease medications could also help with MCI. They are currently studying this.

Researchers are actively studying treatment options for MCI. You may be able to join a clinical trial. Talk to your provider about your options.

Can I prevent mild cognitive impairment?

Not all cases of MCI are preventable. But there are steps you can take to try to keep your brain healthy and reduce your risk of MCI, including:

• Avoiding or quitting smoking.
• Avoiding alcohol or only drinking it in moderation.
• Eating a healthy, balanced diet.
• Exercising regularly.
• Maintaining healthy blood pressure, cholesterol levels and blood sugar levels.
• Minimizing and managing stress.
• Getting quality sleep.
• Exercising your brain by doing puzzles, reading, learning new skills and similar activities.
• Engaging in social activities.
• Seeing your healthcare provider regularly to manage any chronic conditions you have.

What’s the prognosis for mild cognitive decline?

The prognosis (outlook) for mild cognitive decline varies based on the cause and other factors. Researchers are still learning more about this condition.

Studies show that about 15% of people with MCI older than age 65 years developed dementia within two years of the initial MCI diagnosis. They also show that about 14% to 38% of people with MCI returned to their normal cognition level.

The rate of decline in someone with mild cognitive impairment often depends on the underlying cause. Researchers continue to study the mental and medical changes that occur in people with MCI. They hope to one day be able to better predict who might be at an increased risk of developing — and the speed at which they develop — specific types of dementia.

How do I take care of myself if I have mild cognitive impairment?

If you have a diagnosis of MCI, you may want to talk to your healthcare provider and anyone you trust about your future. This is especially important if your provider thinks your MCI is an early stage of a neurodegenerative condition, like Alzheimer’s. These discussions are important because they can help ensure caregivers can honor your wishes if you can’t choose for yourself in the future.

In addition to those conversations, you should put your wishes and decisions in writing. That includes preparing documents connected to legal issues and what happens if you can't care for yourself or make decisions for your care or well-being.

When should I see my healthcare provider?

Because MCI may be an early sign of more serious neurological conditions, it’s important to see a healthcare provider or specialist every six to 12 months. This may depend on your treatment plan. Your provider can help track changes in memory and thinking skills over time and suggest changes that are relevant to your health. Keeping a personal record of any changes can also be helpful.

If you develop any new symptoms, contact your provider.

What questions should I ask my provider about MCI?

If you’ve been diagnosed with mild cognitive impairment, it may be helpful to ask your healthcare provider the following questions:

• What caused my MCI?
• What management options do I have?
• Do I need to see a specialist?
• What signs should I look out for to know if my MCI has gotten worse?
• Will I develop dementia?
• Can I still drive? Should I stop doing other types of activities?
• How can I keep my brain healthy?
• Should I tell people about my diagnosis?
• Are there any local support groups for people with MCI?