Recognizing Mild Cognitive Impairment

Everyone may forget things occasionally as they age, but how do you know when these lapses in cognitive function are a cause for concern? Mild cognitive impairment (MCI) can be seen as a form of memory and cognitive decline that typically falls between typical aging and dementia. Knowing how to recognize it can help individuals and their families monitor their progress and prepare for the future if symptoms worsen. Signs of MCI may include frequent forgetfulness, having trouble following conversations, and missing scheduled events. If you notice these signs in yourself or a loved one, it can be helpful to reach out to a doctor and a therapist for a holistic treatment plan.

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What is mild cognitive impairment (MCI)?

Mild cognitive impairment (MCI) can be seen as a step between expected memory decline due to aging and a more serious form of dementia. People with mild cognitive impairment may realize that their mental function or memory has declined, and friends and family may notice changes, but these changes generally are not significant enough to impact daily life. There isn’t a single outcome for this condition. Some people may have symptoms that remain roughly the same, while others may improve, and still others may go on to develop dementia.

In the US, millions of older adults are estimated to be affected by mild cognitive impairment, and the prevalence of MCI typically climbs with age. It’s thought to affect about 6.7% of people aged 60 to 64 years old and about 25% of those aged 80 to 84. 

Some research shows that between 15% and 20% of people over age 65 may meet the criteria for this diagnosis. Not everyone with MCI will develop dementia, but many people do. One longitudinal study found that of people diagnosed with MCI, 65% had progressed to diagnosable dementia about three years later.

What causes MCI?

Researchers have not identified a unique cause of MCI, but it may be due to early Alzheimer’s disease. Mild cognitive impairment often involves the same type of brain changes seen in other forms of dementia, but to a lesser degree. People with mild cognitive impairment may have beta-amyloid plaques and tau protein tangles in their brains, similar to those seen in Alzheimer’s disease, or Lewy bodies like those seen in Parkinson’s disease. 

Brain imaging has identified brain changes that may be associated with MCI, including a smaller hippocampus, larger fluid-filled spaces called ventricles, and reduced use of glucose in some areas. 

The biggest risk factor for developing MCI seems to be age. Other risk factors may include genetics, diabetes, high blood pressure, smoking, high cholesterol, depression, obstructive sleep apnea, obesity, lack of physical activity, lack of social or mental stimulation, and low education level.

Identifying mild cognitive impairment vs. normal aging

While people may experience occasional forgetfulness as they get older, mild cognitive impairment is not considered a normal part of aging. Much of what differentiates it from normal aging concerns how often someone struggles with cognition or memory. Occasionally forgetting why you walked into a room or where you put something can be fairly common, but when it happens multiple times on a daily basis, it may be something to discuss with a medical professional.

Some symptoms associated with MCI can include the following: 

• Forgetting things more often than usual
• Missing social events or appointments
• Being unable to follow the plot of a movie or book
• Losing your train of thought
• Having trouble following conversations
• Finding it hard to make decisions
• Having difficulty following instructions or finishing a task
• Experiencing challenges getting around familiar places
• Displaying poor judgment
• Experiencing symptoms of anxiety or depression
• Having a lack of interest in things you once enjoyed
• Exhibiting aggression or a short temper

According to the Alzheimer’s Association, there are generally two types of mild cognitive impairment. Amnestic MCI primarily involves memory problems, while non-amnestic MCI tends to affect other thinking skills, like time perception, visual perception, the ability to complete complex tasks, and decision-making. If you have mild cognitive impairment, your friends and family may be likely to notice these changes.

How is mild cognitive impairment diagnosed?

There is currently no way to confirm that someone has MCI, but doctors may use certain criteria to clarify the diagnosis:

• Problems with mental functions, like memory, planning, making decisions, or following directions 
• A medical history that reveals a decline in mental function over time that is confirmed by a close friend or family member
• Memory testing showing a mild level of impairment
• Problems that aren’t severe enough for a dementia diagnosis
• Unaffected daily activities

Prevention and treatment of mild cognitive impairment

There is currently no medication or standard treatment for MCI, but there are some things that may help you stay healthy and manage memory and cognitive changes. Here are some tips to keep your brain active and potentially enhance your memory: 

• Stick to a daily routine
• Use to-do lists, calendars, and other memory tools 
• Learn a new skill
• Spend time with family and friends
• Establish a regular exercise routine
• Prioritize sleep and aim for at least seven hours each night
• Don’t drink alcohol excessively
• Put things you use often in the same place every day 
• Volunteer in your community

MCI as an early sign of dementia

MCI may be an early sign of a more significant memory problem or dementia, so it can be important to see your doctor regularly to track your thinking skills and memory over time. If symptoms progress to dementia, getting an early diagnosis can help you and your family prepare for the future. You may also want to talk to a doctor about whether there is a relevant clinical trial for which you may qualify.

Some research has found that psychotherapy can be effective for people with mild cognitive impairment or who are in the early stages of dementia. While psychotherapy may not improve cognitive impairment, this study shows that it may positively impact depression symptoms and quality of life for people with this condition.

If memory and cognitive function continue to decline, it may become necessary to make significant changes to daily routines. It may be best to evaluate whether it is still safe to drive, and you may need help with household tasks, like cooking, cleaning, or personal care. 

It can be challenging to cope with cognitive decline

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Support for caretakers of people with MCI or dementia

Some individuals with MCI or dementia may need to be reminded to take medications. Caregivers may need to start helping with meals, bathing, paying bills, and ensuring the person attends all scheduled doctor’s appointments and tests. It may be worth discussing things like power of attorney and advance directives soon after diagnosis, when the person still has the awareness to make those decisions.

Being a caregiver for someone with mild cognitive decline often has many benefits, but it can also come with some challenges. Caregivers may enjoy the satisfaction of knowing they are helping someone, which can give them a sense of purpose and meaning in their lives. However, this role can be emotionally draining, and it can lead to high levels of stress, frustration, exhaustion, and financial challenges. 

If you are a caregiver for someone with mild cognitive decline or early dementia, talking to a therapist can help you learn how to manage these challenges. Many caregivers may believe they don’t have time to attend in-person appointments, but with an online therapy platform like BetterHelp, you can attend sessions from the comfort of your home at a time that works for your schedule. Plus, you can change providers at any time for no additional fee until you find the right fit. 

Research shows that online therapy can be effective. A 2023 study suggested that an online intervention could reduce stress and depressive symptoms of caregivers for individuals with dementia.