Mild Cognitive Impairment

What is mild cognitive impairment?

Mild cognitive impairment (MCI) is an intermediate state between normal thinking and memory (cognition) and dementia. Patients with MCI typically have thinking difficulties, with changes on cognitive testing that are greater than expected for one’s age. An individual with MCI, unlike an individual with dementia, may retain his or her ability to manage day-to-day functions, such as medications and finances.

What are the symptoms of mild cognitive impairment?

People with mild cognitive impairment can have difficulty in any of the cognitive domains: memory, language, visuospatial skills, and attention-executive functioning (e.g., the ability to plan, to anticipate, to initiate an action, and to think abstractly). Initial symptoms in those with memory loss often include repetition or forgetfulness. Word finding and naming difficulty can be seen in those with language changes. Individuals who experience difficulty with visuospatial skills may get lost while driving or have difficulty tracking the lines on a page while reading. Impairments in attention-executive functioning can be associated with problems with decision-making, performing multiple tasks simultaneously, or completing one’s train of thought.

What are contributing factors for mild cognitive impairment?

Patients with MCI may be at higher risk for dementia. For example, patients with mild cognitive impairment who primarily have memory impairment and hippocampal atrophy on neuroimaging may be more likely to develop Alzheimer’s disease. However, it is also important to consider other factors that might be contributing to cognitive difficulties.

Contributing factors for MCI include general medical conditions such as hypertension, high cholesterol, diabetes mellitus, thyroid disease and some vitamin deficiencies.  Underlying psychiatric issues such as depression and anxiety can also be associated with MCI. And sleep issues such as untreated obstructive sleep apnea and an inadequate amount of sleep may also contribute. All of these factors are taken into consideration during an evaluation at the Memory Disorders Center.

How is mild cognitive impairment diagnosed?

A physician will begin an evaluation of a patient who is experiencing cognitive difficulties by taking a thorough history and performing a complete physical examination.  A laboratory workup may include thyroid studies, a complete metabolic panel, a complete blood count, and vitamin levels. Imaging of the brain with an MRI or a CT may also be ordered to determine whether there are any structural changes that might be associated with the cognitive changes. If there is a concern about an underlying sleep issue, a sleep study also may be ordered.

What treatments exist?

Treatment for MCI is primarily geared toward easing symptoms. Acetylcholinesterase inhibitors such as donepezil may be considered if the patient is experiencing significant memory changes. If a patient has signs of parkinsonism, medications such as levodopa-carbidopa may be considered. Individuals who have undergone a sleep study that shows evidence for obstructive sleep apnea may benefit from continuous positive airway pressure treatment. And those with underlying depression and/or anxiety may benefit from appropriate medications and a referral for psychotherapy. Treatment of other medical conditions, such a vitamin deficiency, thyroid disease, hypertension, and dyslipidemia, is highly recommended.

Non-medication strategies include remaining cognitively, socially, and physically active.

How can I reduce my risk of mild cognitive impairment?

Adequate treatment of contributing factors, including underlying medical disorders, psychiatric conditions, and sleep issues, is essential. Exercise, other physical activity, and cognitive exercises may also be beneficial.