You can probably name a time when you couldn’t find your car keys or when that word was just on the tip of your tongue. But when is forgetfulness normal, and when does it cross into something more concerning? Is it natural aging, dementia or could it be mild cognitive impairment?
With normal aging, the biggest changes occur in the speed of our thinking, our ability to sustain attention and our multi-tasking capabilities. We might find our speech is not as nimble as word-finding becomes more difficult with age, as does the amount of information we can hold in mind.
But while many of these changes are normal to the aging process, many adults worry about the development of dementia, the decline of cognitive functioning to such an extent that it interferes with a person’s daily activities. Some people with dementia cannot control their emotions, and their personalities may change.
In between normal aging and dementia lies mild cognitive impairment (MCI). MCI is diagnosed when a person’s symptoms are worse than would be expected for a healthy person their age but are not severe enough to significantly affect their daily life.
MCI is not a type of dementia, but some people who have MCI will go on to develop dementia. Researchers have found that the majority of people with MCI ultimately develop Alzheimer’s disease or a related type of dementia, so it’s very important to answer the question: Is this normal aging or is this MCI?
“It’s important to distinguish MCI from normal aging and do that as early as possible,” explained Morgan Daven, national senior director for health systems for the Alzheimer’s Association. “We know that about one in seven Americans aged 60 and older have some form of MCI, and it’s important to know because in some cases, MCI can progress to dementia, and also, depending on the cause, some of those causes are treatable. Not everyone who has MCI will go on to develop dementia, but studies do suggest that about 10-15% of individuals with MCI will develop dementia each year. And again, that’s part of why it’s so important to talk with your doctor for yourself or for a loved one.”
Answering this question early means that early intervention is possible, which has numerous benefits.
Why early intervention is important
An accumulated body of research indicates that early interventions can improve cognitive function and reduce the risk for dementia progression in people with MCI. For example, individuals at increased risk for later Alzheimer’s disease (AD) development that instigate early intervention – and are treated in the prodromal stage (the stage of obvious brain dysfunction) – can delay or even prevent their advancement to AD.
There are many medical, emotional, social and economic reasons to make an appointment today if you suspect your loved one might have MCI.
A checkup visit that allows your doctor to catch MCI and order further testing can allow you early access to treatment options such as aducanumab (Aduhelm), which removes amyloids – one of the hallmarks of Alzheimer’s disease – from the brain. The earlier you take this medication, the more effective it may be at reducing the cognitive and functional decline in people living with early Alzheimer’s.
Reversal of dementia-like symptoms
Sometimes MCI is caused by conditions that can be managed or reversed. A doctor may identify and treat these causes.
“Some of the causes of MCI can be treatable—things like depression or side effects from certain medications or even a sleep disorder like sleep apnea, which can be quite common, especially in an older population,” Daven said. “There are a number of treatable things that are fairly common that could be causing the MCI.”
These conditions include:
- Infections and immune disorders
- Metabolic problems and endocrine abnormalities
- Nutritional deficiencies
- Reactions to medications
- Subdural hematomas
- Poisoning from heavy metals, pesticides, alcohol or recreational drugs
- Brain tumors
- Anoxia (also called hypoxia)
- Normal-pressure hydrocephalus
Some people with MCI participate in clinical trials or studies, which are research studies that help test if a treatment or diagnostic test is safe and effective in people. Clinical trial participation allows MCI patients to gain access to cutting-edge experimental treatments that could potentially delay the progression of the disease and prevent the disease from causing more serious impairment.
“There is now the first treatment that addresses the underlying biology of the disease, and there are numerous other clinical trials,” Daven said. “There are also many additional therapies under development. But getting that MCI detected early and getting that follow-up early is key.”
To learn more about participating in these types of clinical trials, visit Alzheimers.gov or call the Alzheimer’s and Related Dementias Education and Referral (ADEAR) Center at 800-438-4380.
Emotional and social benefits
Sometimes having an answer to why you’re experiencing your symptoms actually eases your anxiety. Early intervention also allows you and your family the opportunity to maximize your time together and access support programs.
More time to plan for the future
End-of-life planning is complicated; it’s even more complicated when dementia is involved because the loved one cannot express their wishes about legal, financial and end-of-life decisions. However, if MCI is identified early, you and your loved one may have more time to complete the necessary legal documents, arrange finances and property, and identify your care preferences. You can also address potential safety issues, such as driving or wandering, ahead of time.
How friends and family can detect MCI in their loved one and ensure early intervention
Identifying MCI in your loved one can be difficult, as it can be challenging to ascertain between normal aging and MCI. Below are symptoms to watch for:
Mood changes – Examples include a lack of initiative or motivation in the absence of depression; depression; irritability and aggression; anxiety; apathy; impulsiveness; showing increasingly poor judgment.
Memory impairment – Examples include forgetting recent events; repeating the same question; trouble remembering details from recent conversations; difficulty remembering items while shopping; trouble finding words.
Reasoning, planning or problem-solving – Examples include struggling with thinking things through; difficulty keeping up with bills and finances or staying on top of day-to-day tasks at home; relying on a notebook or printed calendar to keep track of your schedule; increasingly overwhelmed by making decisions, planning steps to accomplish a task or understanding instructions; trouble with managing bills or accounts.
Attention deficits – Examples include being very easily distracted; losing train of thought or the thread of conversations, books or movies.
Visual depth perception issues – Examples include struggling to interpret an object in three dimensions; judging distances or navigating stairs.
Disorientation – Examples include uncertainty about the ability to drive to a familiar location and resorting to GPS; starting to have trouble finding your way around familiar environments.
For a person with MCI, these changes will only cause minor problems with daily tasks. If there is a significant impact on everyday activities, this may suggest dementia.
Either way, intervention is key. Daven recommends getting involved as soon as you notice any of these symptoms in a loved one. Talk to your loved one, but also join their conversation with the physician. Daven emphasizes the important role a caregiver plays in communication.
“As cognitive impairment progresses and as it moves into dementia – and as dementia progresses – it becomes more and more important for the caregiver or care partner to be involved in communication. We really encourage physicians to start working with that care partner early – and certainly with a dementia diagnosis – hopefully to find it early enough that both a person living with the disease and their caregiver can be involved in care planning and making decisions that really reflect what’s important to the person who is living with the disease. That care partner or caregiver involvement as early as possible is really, really important.”