Mild Cognitive Impairment
Mild Cognitive Impairment (MCI) is an intermediate stage between the subtle cognitive changes expected in normal aging and the more severe decline that occurs in dementia.
Early detection of MCI is critical – read on to understand the signs, diagnostic process, treatment options, and how Sunday Health can support with testing and ongoing support.
Overview
Mild Cognitive Impairment (MCI) lies between normal cognitive aging, where one might experience subtle changes in thinking, and the dementia syndrome, in which cognitive impairment is severe enough to interfere with one's ability to do the things one usually does.
In other words, MCI causes more cognitive trouble than normal cognitive aging but much less trouble than Alzheimer's disease and related dementias (ADRD).
People with MCI remain functionally independent for the most part. They can still drive, manage finances and medications, cook, do laundry, and engage in their usual leisure activities, though these tasks might take longer or require more effort than before. In contrast, people with dementia have lost the ability to accomplish most or all of these tasks.
Key facts about MCI:
- It is estimated to affect 10 - 20% of adults aged 65 and older.
- It's often, but not always, a transitional stage between normal cognition and dementia.
- On average, people with MCI involving memory have approximately a 12-15% chance each year to progress to Alzheimer's disease.
- Some cases of MCI remain stable or even improve rather than progressing to dementia.
- Early detection and intervention can help maintain quality of life and independence.
- Yet recent studies indicate that 92% of Americans experiencing MCI are not getting diagnosed at an early stage.
of adults 65 and older have MCI
of those with MCI are not diagnosed in early stages
change, each year, that MCI involving memory progresses to Alzheimer's
Symptoms
As we age, subtle changes in our thinking, memory, and attention are natural—just like graying hair or aching knees. However, it's important to distinguish between normal cognitive aging and signs that something more serious might be happening.
Normal Aging:
- Occasionally forgetting new names or appointments, but remembering them later
- Making occasional errors when managing finances or household responsibilities
- Sometimes having trouble finding the right word (the word is on the 'tip of your tongue')
- Occasionally losing things and having to retrace steps to find them
- Needing more time to learn new technologies or skills
MCI Warning Signs:
- Repetitive questioning: Asking the same question multiple times in a day or having trouble following a conversation
- Attention lapses: New struggles to follow the plot of a television program or novel
- Getting lost in familiar areas: The hippocampus, the part of the brain that helps us remember things, is also involved in supporting our navigational abilities, meaning that getting lost can be a warning sign
- Mood changes: Sometimes impending cognitive impairment reveals itself via depression, anxiety, or increased irritability
- Other changes, such as:
- Consistent difficulty remembering recent events or conversations
- Increasing trouble with planning, organizing, or making decisions
- Difficulty completing complex tasks that were previously manageable
- Decreased interest in social activities or hobbies
Diagnostic Process
Early detection of MCI is crucial for timely intervention. The diagnostic process typically involves several steps to rule out other conditions and confirm the presence of mild cognitive impairment.
The Four Criteria for MCI Diagnosis
- A subjective cognitive complaint (e.g., "Doctor, my memory isn't what it used to be")
- An objective impairment in at least one area of thinking (found through detailed cognitive testing, known as a neuropsychological evaluation)
- Normal "general cognition" (i.e., unimpaired performance on basic cognitive screening)
- "No dementia," meaning no notable decline in functional abilities due to cognitive issues
What to Expect in a Cognitive Assessment
At Sunday Health, cognitive assessments form the backbone of our care for older adults with cognitive concerns. Our comprehensive assessment process includes:
Pre-Visit Online Testing:
- Completed at your convenience on a computer or tablet
- Takes about 15 minutes
- Tests attention, mental flexibility, and memory
- Screens for depression and anxiety
First Face-to-Face Appointment:
- Conducted virtually via secure telehealth or in person at our Vienna, VA location
- Additional brief screening to compare with pre-visit results
- Discussion of medical history, lifestyle, and cognitive concerns
When Additional Assessments are Necessary:
- In-depth neuropsychological testing may be recommended, performed by our neurologist
- Examines specific cognitive domains in greater detail
Our cognitive assessments provide valuable insights into:
- Overall cognitive status
- Your specific strengths and weaknesses
- Attention and concentration abilities
- Processing speed
- Memory capabilities
- Language skills
- Executive functioning
- Impact of other medical or psychological conditions
Advanced Diagnostic Tools
Beyond traditional cognitive testing, Sunday Health leverages diagnostic technologies for more precise results:
- Blood-Based Biomarkers: New blood tests can detect proteins associated with Alzheimer's disease in its earliest stages
- Brain Imaging: MRI and PET scans can identify structural changes and protein deposits in the brain
- Genetic Testing: May be recommended in some cases, especially with strong family history
Treatment & management options
While there is no cure for MCI, several approaches can help manage symptoms, improve quality of life, and potentially slow progression.
Medications:
In July 2023, the FDA granted full approval to a new type of medication — the monoclonal antibody drug class (mAbs) — to treat MCI involving memory and early Alzheimer's disease. The two approved medications are:
- Lecanemab (Leqembi)
- Donanemab (Kisunla)
Clinical trials show that they can slow cognitive decline by up to 35% in patients with early-stage disease, marking a major step forward in dementia treatment.
While not a cure, these drugs offer a real opportunity to extend quality of life and independence. It is worth noting that these treatments require careful monitoring by healthcare professionals and that some individuals have experienced notable side effects.
Lifestyle Interventions:
If you've been diagnosed with MCI, there are steps you can take right now to help ensure you're living your best possible life:
- Optimize Medical Conditions: Work with your healthcare team to maximize control of vascular conditions impacting cognition (diabetes, high blood pressure, high cholesterol).
- Medication Review: Have your healthcare practitioner review your medications to minimize any that could be worsening cognitive function. Questions to ask about any new medication:
- Is this medication okay for people with memory problems?
- Will this medication have any anticholinergic side effects?
- Is this medication on the Beer's List of medications that older adults should avoid?
- Address Mood Issues: Take immediate steps to address symptoms of depression and anxiety if they occur. These conditions can adversely affect happiness and quality of life in addition to cognition, and they are treatable conditions.
- Cognitive Rehabilitation: Ask your clinician about structured programs that can help develop compensatory strategies for memory and thinking difficulties.
- Assistive Technology: Smartphone apps, electronic calendars, and reminder systems can support daily functioning.
- Long-Range Planning: This is an excellent time to address advance directives, healthcare proxies, and financial planning.
Prevention strategies
Research shows that adopting healthy lifestyle habits can significantly reduce your risk of developing MCI or slow its progression. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study and subsequent global research have demonstrated that multi-domain lifestyle interventions can protect brain health.
Evidence-Based Prevention Strategies:
- Physical Activity: Regular exercise improves blood flow to the brain and promotes neuronal growth.
- Mediterranean-Style Diet: Eat a diet high in vegetables, legumes, fruits, nuts, cereals, fish, and olive oil. Limit ultra-processed foods and consumption of soda.
- Cognitive Stimulation: Engage in mentally challenging activities. The more variety in your cognitive activities, the better. Reading, taking classes, or learning new skills all help keep our brains active and flexible.
- Social Engagement: Maintain a broad and robust social network to stay engaged with the people and places around you.
- Sleep Optimization: Prioritize good sleep habits to allow your brain to clear toxic proteins overnight.
- Vascular Health Management: Control blood pressure, cholesterol, and blood sugar levels.
- Sensory Health: Address hearing and vision issues promptly.
- Protect Your Head: Prevent traumatic brain injuries by taking safety precautions.
If you are wondering about MCI or if you have been diagnosed with MCI, Sunday Health can help support and guide you throughout your journey with this condition. Schedule a consultation with Sunday Health today, and take the first step toward a future of longer, healthier, and more independent living.
- https://www.adrc.wisc.edu/dementia-matters/our-evolving-understanding-mild-cognitive-impairment
- Petersen RC, Lopez O, Armstrong MJ, Getchius TSD, Ganguli M, Gloss D, Gronseth GS, Marson D, Pringsheim T, Day GS, Sager M, Stevens J, Rae-Grant A. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018 Jan 16;90(3):126-135. doi: 10.1212/WNL.0000000000004826. Epub 2017 Dec 27.2.
- Fink HA, Jutkowitz E, McCarten JR, Hemmy LS, Butler M, Davila H, Ratner E, Calvert C, Barclay TR, Brasure M, Nelson VA, Kane RL. Pharmacologic Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia: A Systematic Review. Ann Intern Med. 2018 Jan 2;168(1):39-51. doi: 10.7326/M17-1529. Epub 2017 Dec 19.
- van Dyck CH, Swanson CJ, Aisen P, Bateman RJ, Chen C, Gee M, Kanekiyo M, Li D, Reyderman L, Cohen S, Froelich L, Katayama S, Sabbagh M, Vellas B, Watson D, Dhadda S, Irizarry M, Kramer LD, Iwatsubo T. Lecanemab in Early Alzheimer's Disease. N Engl J Med. 2023 Jan 5;388(1):9-21. doi: 10.1056/NEJMoa2212948. Epub 2022 Nov 29.
- Sims JR, Zimmer JA, Evans CD, Lu M, Ardayfio P, Sparks J, Wessels AM, Shcherbinin S, Wang H, Monkul Nery ES, Collins EC, Solomon P, Salloway S, Apostolova LG, Hansson O, Ritchie C, Brooks DA, Mintun M, Skovronsky DM; TRAILBLAZER-ALZ 2 Investigators. Donanemab in Early Symptomatic Alzheimer Disease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial. JAMA. 2023 Aug 8;330(6):512-527. doi: 10.1001/jama.2023.13239.
- Gomes Gonçalves N, Vidal Ferreira N, Khandpur N, Martinez Steele E, Bertazzi Levy R, Andrade Lotufo P, Bensenor IM, Caramelli P, Alvim de Matos SM, Marchioni DM, Suemoto CK. Association Between Consumption of Ultraprocessed Foods and Cognitive Decline. JAMA Neurol. 2023 Feb 1;80(2):142-150. doi: 10.1001/jamaneurol.2022.4397.
- https://www.americangeriatrics.org/media-center/news/many-older-adults-take-multiple-medications-updated-ags-beers-criteriar-will-help
- https://www.wired.com/story/nearly-everyone-with-mild-cognitive-impairment-goes-undiagnosed/
Frequently asked questions
How can I tell if my memory changes are normal aging or MCI?
Our cognition changes as we age; however, memory loss is not a part of normal aging.
The following changes also fall outside of normal aging:
- Repetitive questioning
- Attention lapses
- Getting lost in familiar areas
- Mood changes
If memory or thinking changes are concerning you or your loved ones, interfering with daily activities, or getting worse over time, it is best to seek a professional evaluation.
If I have MCI, will I definitely develop dementia?
While MCI increases the risk of developing dementia, not everyone with MCI will progress to dementia. Specific predictions cannot yet reliably be made about whether, and if so, when, a given person might be likely to transition from MCI to ADRD. On average, people with MCI involving memory have approximately a 12-15% chance each year to progress to AD.
What should I do if I'm concerned about my cognitive health?
It is important to not wait to address cognitive concerns. Early detection allows for more effective interventions and better long-term outcomes.
As a first step, you can schedule a visit with your primary care practitioner to discuss your concerns and symptoms, and request a cognitive screening.
If you reside in DC-MD-VA: You can schedule a complimentary introductory call with our team to discuss your concerns and explore our approach to cognitive wellness. Click here to get started.
We are accepting new patients in Maryland, Virginia and Washington D.C.
