Memory loss lies on a spectrum. Dementia and Alzheimer's are on the advanced end, whereas their earliest signs—called mild cognitive impairment (MCI)—are on the other. A person with MCI may not be able to recall the details of a conversation or may need assistance with activities of daily living, such as paying bills on time or remembering upcoming doctor’s visits. Some forms of MCI are caused by lifestyle factors and are reversible. Others are considered neurodegenerative, meaning that with age the brain breaks down and shrinks more than is normal. According to research, about 10 to 20 percent of people over the age of 65 who have MCI develop dementia over a one-year period. Not everyone with MCI will experience Alzheimer’s disease or dementia but may continue to live with mild impairment long-term.
Who is at risk of developing MCI?
Dementia and its early form, MCI, have a genetic component. People with a family history of Alzheimer’s or other forms of dementia may have an increased chance of developing these conditions in the future.
Increased risk factors also include those who have experienced repetitive head trauma, injury concussions, partial strokes, or other impairment of the brain itself, such as a blood clot or tumor. Excessive use of alcohol or illicit substances and tobacco use can increase an individual’s risk.
What are signs and symptoms of MCI?
Often a patient’s loved ones are the first to notice that their friend or family member is having more difficulty living and managing their affairs on their own. Here are some changes they may notice:
How is MCI diagnosed?
When a patient has symptoms of MCI, we initially check for potential non-neurological causes. These could be nutritional deficiencies or sleep disorders. If those ruled out, brain imaging with a CT scan or MRI can show if the patient is experiencing a loss of brain volume greater than expected for their age.
The final component of diagnosis is a cognitive assessment, a 15-minute test that usually takes place at our clinic. The test covers visual and verbal memory, short-term and long-term recall, and numerical computational skills. If more testing is needed, we may refer you to a neuropsychiatrist for a longer, three- or four-hour assessment.
What does treatment for MCI look like?
If a metabolic or lifestyle factor may be contributing, we address that issue. If we suspect that brain breakdown is behind the condition, tests are repeated periodically to track the patient’s performance over time.
Certain medications may slow down the progression of cognitive decline. Memantine and donepezilare are well established agents. We also review all the patient’s medications to check for ones that may impair memory.
What are ways to manage MCI?
Approach your brain like any other part of your body. Give it the care and workouts it needs by increasing the number of cognitive exercises and puzzles you engage in. Here are some steps you can take to manage living with MCI:
When a patient is no longer able to get through the activities of daily living independently, they may be progressing beyond MCI. As a family member, you can ask yourself whether you would feel safe leaving your loved one home alone for the weekend. If not, discuss your concern with their doctor.
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Jaspreet Singh Johal, MD and the team at Cayuga Neurologic Services provide neurologic care to Ithaca and the surrounding region. Dr. Johal’s clinical interests include cognitive disorders, diabetic and peripheral neuropathy, electrodiagnostics and headache. Cayuga Neurologic Services can be reached in Ithaca (905 Hanshaw Road, Suite A) at (607) 273-6757 or in Cortland (260 Tompkins Street) at (607) 428-8004.
