Mild Cognitive Impairment 101

Mild Cognitive Impairment, also referred to as MCI and Mild Neurocognitive Disorder, has generated a lot of research over the last 15 years. However, what it is and how to treat it can vary considerably, depending… On what? First, let’s get the definition out of the way. Simply put, MCI is a diagnosis that refers to the somewhat ambiguous area between normal cognition and dementia. This means that there has been a noticeable decrease in someone’s memory, judgment, speech, or other cognitive ability, that is not so severe that (s)he qualifies for a diagnosis of dementia. Generally speaking, people with MCI can function in their day-to-day life with little to no assistance. These individuals can usually mask or compensate for their cognitive difficulty by writing notes for themselves, setting alarms, or utilizing other similar strategies to keep up with their responsibilities at home and at work. Friends and family members often notice that something seems “off,” but acquaintances typically remain unaware that there is any problem at all.

Although this is a scary analogy, you should know that there are different types of MCI, just like there are different types of dementia and different types of cancer. Some are more serious and life-altering than others. For instance, someone who has significant memory loss in the context of otherwise normal cognitive functioning, would be given a diagnosis of MCI, Amnestic Type. You can remember this by imagining a person with amnesia (amnesia = amnestic). This type of MCI is most predictive of Alzheimer’s disease. While there isn’t a hard and fast rule that someone with Amnestic MCI will definitely develop Alzheimer’s disease, unfortunately, there is a good chance that things will be moving in that direction within the next few years. The rate of disease progression- or how quickly this process may occur- will vary based on a person’s age, physical health, mental health, and genetics. It’s impossible to give a specific timeframe, but you can probably delay the transition to dementia by addressing any contributing factors and implementing some interventions and lifestyle changes. I’m talking about getting your health problems under control, exercising on a regular basis, switching to a heart-healthy diet, reducing stress, and learning compensatory strategies such as the ones I mentioned above.

The causes and trajectory of the other MCI types aren’t quite as apparent. These include Non-Amnestic MCI and Multi-Domain MCI, each of which can be broken down even further. For brevity’s sake, I won’t be discussing these variations in great detail. But let’s review the cognitive domains so that you at least have a general understanding of what these diagnoses mean. When a doctor refers to cognitive domains, (s)he is basically talking about your thinking skills. Your thinking skills fall into several categories (i.e. domains), which include: memory, language, attention, executive functioning, and visual-spatial ability. Processing speed and sensorimotor functioning are often assessed as well. Therefore, Non-Amnestic MCI translates to impairment in any of those domains except memory, and I will assume that Multi-Domain MCI is self-explanatory. I do realize that I just introduced several more terms that might as well be written in another language. Since this is a CliffsNotes guide to MCI, however, please bear with me.

So I’ve already established that a diagnosis of MCI with predominant memory loss (Amnestic MCI) has been linked to the development of Alzheimer’s disease. There are also certain combinations of cognitive deficits (Multi-Domain MCI) that are associated with the development of other types of dementia. In addition to one’s physical symptoms, psychiatric symptoms, lab tests, and the results of neuroimaging (e.g. CT scan, PET scan, MRI), this possibility can usually be determined with good accuracy. But let’s shift our focus away from dementia and end this thing on a slightly more positive note. Let’s direct our attention to MCI, Non-Amnestic Type. Relatively speaking, this diagnosis is considered to be less devastating. A person with Non-Amnestic MCI, for example, could have impaired language skills due to a head injury or stroke. Unless this individual suffers another injury, there is no real indication that the MCI will progress to dementia. In fact, the benefits of speech therapy plus the body’s natural ability to heal over time, could reverse this person’s language impairment altogether. MCI caused by a vitamin deficiency, sleep deprivation, psychiatric illness, or untreated or poorly treated medical condition such as an infection, thyroid disorder, diabetes, or sleep apnea, can be reversible as well.

The bottom line? Don’t attempt to diagnose yourself. We are notoriously bad at diagnosing our own symptoms, myself included! You might be convinced that you have memory loss when what you really have is an attention deficit. Or you might be convinced that you have an attention deficit when the real problem is that you’re only obtaining four hours of sleep at night, guzzling five cups of coffee by noon, and snacking on candy and potato chips. You get my point. Instead, schedule an appointment with a neurologist and/or neuropsychologist for a cognitive evaluation. An evaluation will clarify your symptoms, provide you with a diagnosis, and identify any contributing factors that you might have overlooked. Although you could understandably feel hesitant about the possibility of receiving bad news, this information is important. This information is important because it will help to determine your treatment options and give you the opportunity to make plans for your future and the future of your family.

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