Is It Mild Cognitive Impairment or Dementia?

Published In Health & Well-Being

June 3rd, 2016

As studies of brain health and aging focus and evolve, the term “Mild Cognitive Impairment,” or MCI, is frequently bandied about by doctors and other care providers—and often without much explanation. MCI, also referred to as “Major Neurocognitive Disorder is basically a transitional state straddling the area between normal aging and dementia. Many conditions can lead to MCI, and later, dementia — including Alzheimer’s and Parkinson’s diseases, strokes, head trauma, deficiencies in certain vitamin and hormones, and depression.

Dementia refers to a pathological decline in cognitive function—that is, thinking, memory, and reasoning — due to changes in the brain. In some people, it causes a degeneration that leads to significant impairment in the basic functions — clinically called Activities of Daily Living (ADLs), or in higher-level daily living functions—called Instrumental Activities of Daily Living (IADLs).

Looking at these abilities is a critical part of diagnosing dementia, because they basically form the divide between normal and borderline functioning.

ADLs are the abilities to act independently to take care of basic needs, including:

  • Dressing
  • Eating
  • Using the bathroom
  • Keeping clean—washing the body and brushing teeth, and
  • Moving about and walking.

Abilities considered IADLs include:

  • Balancing a checkbook
  • Handling financial transactions, such as making change
  • Driving a car
  • Cooking meals, and
  • Using a telephone or computer.

The higher level functions, those learned later in life that require more complex mental operations, are what tends to “go” first in a person who has dementia, particularly in the early stages. So from a practical standpoint, you, your parent, spouse, or other loved one may be perfectly able to function independently at home despite a diagnosis of Alzheimer’s or some other dementia, but may be unable to drive a car safely, or to balance a checkbook.

This corresponds with the experience of early diagnosis and identification for many caregivers and family members of people with early-stage dementia. Unfortunately, one of the earliest signs that “something is wrong” with a person who turns out to have dementia are car crashes or near-misses when driving, and — sometimes even more traumatically — major financial losses.

Why an MCI Diagnosis Matters

The concept of MCI is potentially useful because it may represent the opportunity to identify the dementia syndrome before it becomes clinically problematic — and then plan and possibly offer some psychosocial and medical interventions to reduce risk and possibly even delay the onset of full-blown dementia.

MCI may be discovered through a number of methods.

  • Medical exam – Doctors, particularly geriatricians who focus on aging patients, may gather information from blood and urine tests, as well as a neurological exam and study of the medications the patient takes currently.
  • Cognitive testing results – Most commonly, early tests will show a “modest” decline—that is, the scores will be low, but not super low. Also, the testing doesn’t have to be full-fledged neuropsychological testing—which usually takes several hours—but can be accomplished via brief cognitive screening with one-page instruments such as the St. Louis University Mental Status (SLUMS) exam or the Montreal Cognitive Assessment (MOCA) test
  • Empirical evidence – If testing isn’t available, then the thoughts and observations about the afflicted person (from a caregiver, family member or doctor) may be reviewed to signal if there is some cognitive or memory decline.

The deficits identified do not necessarily interfere with independence in activities of daily living, but there may be greater effort, or compensatory strategies or accommodation to cope with life. In other words, while a person may still be able to perform activities of daily living, it might be a bit of a struggle.

While MCI may be a harbinger of later dementia for some people, it’s also important to note that this is not the case for everyone. According to some studies, about half the people with MCI developed full-blown dementia in five years. The other half either stayed the same or converted to normal, intact cognitive functioning during that time; for them, the condition may have a reversible cause.

What Might Help

A number of lifestyle changes and precautions may help improve brain health and potentially slow the effects of degeneration, no matter its cause.

  • Staying socially engaged – Individuals who have lots of social activities and friends tend to be at lower risk for developing dementia in later life.
  • Engaging in mindfulness – Mindful activities include meditation and physical movement such as yoga and tai chi.
  • Eating the “Mediterranean diet.” – Some studies have shown that a diet emphasizing fresh vegetables, fish, lean protein, healthy fats such as olive oil, and is low in red meat and saturated fat might also help improve brain health.
  • Taking Vitamin E or soy protein supplements – While there may never be a “nutriceutical” magic bullet for dementia, there has been some positive buzz about these two dietary supplements that may be worth considering.
  • Getting mood disorders under control – Since depression in older adults often presents with concentration and memory problems, people with MCI and a history of major depression or anxiety disorder should be thoroughly evaluated and treated for any underlying mood issues.
  • Addressing metabolic risk factors – Those with MCI and high cholesterol, hypertension, diabetes, or hyperlipidemia should follow the common advice when it comes to diet, such as limiting salt and sugar. For people who are also sedentary and obese, getting weight under control and starting a medically appropriate exercise program could be critical in remaining free of dementia.
  • Treating sleep apnea – Obstructive sleep apnea, which basically means a person stops breathing multiple times during the night, is deleterious for brain health. Not only does untreated sleep apnea mean poor sleep, which doesn’t help in thinking clearly for anyone, it essentially can damage the brain over time due to chronic hypoxia.
  • Doublechecking medications – The medical world is increasingly recognizing that a number of commonly used medications—including many over-the-counter drugs represent an independent risk factor for developing later problems with dementia.

Consult with a doctor to see whether some of the usual suspects may be reduced or eliminated. These medications may include:

  • Ativan
  • Benadryl
  • Limbitrol
  • Luminal
  • Skelaxin
  • Sominex
  • Tavist
  • Valium, and
  • Xanax

What Probably Won’t Help

There are also some “solutions” commonly offered to improve brain health that have been shown to have little to no effect.

  • “Brain games” – Despite their popularity and claims that some computerized games may help improve brain health, a group of scientists and neurologists recently took the unusual step of banding together to rebut these “exaggerated and misleading claims”. Their bottom line is that more research and validation is required.
  • Most food supplements – While some tout the benefits of Ginkgo biloba, turmeric, fish oil, multivitamins, and any number of other supplements, there is no one dietary supplement that’s come out as a panacea for prevention. Vitamin E and soy protein, mentioned earlier, offer some possibilities.
  • Alzheimer’s medications – Despite the fact that the medications Aricept (Donepezil) and Namenda (Memantine) are FDA-approved and some claim they help treat some symptoms of Alzheimer’s disease, clinical trials thus far have not found them to be effective for treating MCI. One reason may be that many people with MCI in fact may just have other, reversible conditions such as depression or a chronic illness, and therefore these drugs aren’t effective for them.

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