Managing Mild Cognitive Impairment
Memory loss seems to a natural part of the aging process. But some memory problems may go over the limit of what constitutes normal aging and affect your ability to function in your daily life like getting lost on your way home from a familiar store. What you might be dealing with are early signs of dementia.
Mild cognitive impairment (MCI) describes the intermediate stage between the expected decline of normal aging and the more serious decline of dementia. Dementia is an umbrella term where the level of mental decline affects your ability to function on a day-to-day basis. Unlike those with dementia, people with mild cognitive impairment are able to handle their daily tasks. They may be less efficient than they used to be, but they can live independently.
Mild cognitive impairment is classified in two forms, amnestic and non-amnestic. In amnestic MCI, memory is significantly impaired while other cognitive functions like language or executive function skills are spared. In non-amnestic MCI, memory remains intact with other cognitive abilities impaired.
The cause of MCI is not yet understood. Though individuals with MCI are more likely to develop Alzheimer’s disease (the most common cause of dementia), it is not a certainty. An estimated 15 percent to 20 percent of people over age 65 meet the criteria for MCI. Conditions such as diabetes, depression, and stroke may increase a person’s risk for MCI.
The signs of MCI are inability to form memories of events that just happened and the slight shrinking of the hippocampus, the area of the brain where those memories are stored. Other symptoms may include feeling overwhelmed by making decisions, becoming more impulsive and having poor judgment, and not following the gist of a conversation.
Distinguishing MCI from the effects of normal aging can be challenging. Problems like depression, vitamin B12 deficiency, medication side effects, or an underactive thyroid can mimic MCI symptoms. But there are pronounced differences between MCI and Alzheimer’s disease.
A person with Alzheimer’s disease is much more impaired. They may have trouble interpreting something they are reading or writing a sentence correctly. They may have trouble concentrating, reasoning, or doing simple math problems. They may get lost driving. The disorientation, mood shifts, personality changes, and aggression that may be a part of Alzheimer’s aren’t present in MCI.
Certain factors are associated with more rapid progression towards Alzheimer’s disease such as the presence of a gene, APOE e4, which is more common in patients with Alzheimer’s disease (but having the gene doesn’t necessarily mean poor cognitive function); a reduced hippocampus; and a low metabolic rate in the temporal and parietal regions of the brain. Another characteristic found at autopsy of MCI patients are beta-amyloid protein clumps or plaques and protein clumps of tau or tangles.
But it is important to note that amyloid plaques in the brain, an indicator of Alzheimer’s disease, have also been found in people with perfectly normal cognitive function.
Diagnosis of MCI requires a complete medical history, a neurological exam to evaluate the functioning of nerves and reflexes as well as balance and coordination, brain imaging tests like magnetic resonance imaging scan (MRI), blood tests, cognitive testing, and of course input from the individuals in the patient’s daily life to assess properly mental status and level of independence.
For example, in a typical test for MCI, a patient may be asked to repeat a string of words, or multiply two numbers, or who the first and current presidents are, and finally to recall the initial word list. A person with normal recall may stubble, but with a hint may remember some words. A person with MCI won’t be helped by the hint because the memory was never stored.
There are no drugs or medical treatments to address MCI. Medication like donepezil and memantine that are prescribed for Alzheimer’s disease, may ultimately halt the progression of MCI, can be useful temporary treatments that may stabilize patients for a few years.
It is also important to reduce cardiovascular risk factors like elevated cholesterol, smoking, and high blood pressure; keep blood sugar at normal levels; minimize stress (which some studies show may shrink the hippocampus); and avoid anticholinergic drugs that interfere with brain chemicals important to memory. These include Demerol to treat pain, Detrol, to treat a leaky bladder, tricyclic antidepressants, Valium, and over-the-counter medications like Benadryl and Tylenol PM.
Some evidence suggests that alternative treatments like ginkgo biloba may be beneficial for those with MCI. In fact, one Chinese study shows that ginkgo biloba may improve cognitive function and daily living activities in patients with MCI. But some results were inconsistent. Some studies suggest exercise may help with cognition. For instance, one Archives of Neurology study found that moderate exercise was associated with reduced risk of having MCI.
Also, people with MCI should engage in social activities, mental challenges, and stimulation (e.g. solving a puzzle or learning a foreign language). And a diet of lean protein, healthy fats, fruits, vegetables like dark leafy greens may play a role in improved cognition as well as good cardiovascular health. With enough interventions, mild cognitive impairment can stay mild for many years.
