Understanding the Difference Between MCI and Dementia
If memory and thinking disturbances become more than minor episodic events as we age, and if they start to impair everyday functioning, then MCI might be to blame.
This is vitally important because, while we still don’t have treatments that prevent progression of Alzheimer’s and other degenerative dementias, treatments that can help control symptoms are available.
Symptoms
People with Mild Cognitive Impairment (MCI) have changes in memory, language or thinking that are greater than those typically expected in ageing. The person either notices it, or family or friends notice it, but they are still able to take care of themselves. They might improve over time, or they could be at increased risk of progressing to dementia from an Alzheimer’s or other brain disease.
Your doctor will conduct a detailed interview and examine you for signs of family disease and current symptoms. He will also conduct a physical and mental status examination, and most likely order a certain set of blood or urine tests to rule out infectious, inflammatory and other medical problems that can affect the brain; for example, thyroid disease and vitamin B12 deficiency. The doctor may also order a CT scan or an MRI to rule out other illnesses and to see how the brain is functioning.
Diagnosis
Normal people misplace things from time to time but, if this happens more often than usual and the spaces affected by the loss are larger than normal – and affect more of the brain’s functions than the norm – the person may have MCI. In that case, get yourself along to the doctor.
A primary care physician can conduct a physical exam, request blood or urine tests to look for signs of other possible causes of the MCI such as thyroid disease, lead poisoning, vitamin deficiencies and other factors. They might ask questions about family history and dementia and might request a mental status examination and test of cognitive functions.
In MCI, thinking or memory functioning can be impaired in a single domain, one of word-finding, spatial orientation or declining ability to carry out complex tasks, but individuals may still be able to conduct their daily activities and enjoy a fair level of life quality – in contrast to dementia. Some individuals with MCI will progress to Alzheimer’s or other type of dementia, but not all.
Treatment
If your doctor suspects MCI, he or she might request a spinal tap (lumbar puncture) to test your cerebrospinal fluid as well as perform imaging tests such as CT and MRI scans. Your health and medical history will also be questioned.
This might be why many patients with MCI experience relief once they get a diagnosis. They can face the future, worrying less about ‘What does it mean for my family?’
MCI – mild cognitive impairment – is indeed a risk factor for dementia, but not all people with MCI will develop dementia; many factors can cause it, including some medicines, stroke or a gene called APOE e4.
In cases where MCI is reversible, symptoms can improve once the health problem is treated. In other cases, knowing that a patient has MCI can help clinicians track people at risk for dementia by providing a baseline against which to compare a later one. It can also point to treatment options that can lower the risk of progression to dementia, such as taking medication, reducing alcohol use, or exercise.
Prevention
But often, the MCI is already noticed by the patient, who will report memory problems to his/her physician. At that point, the physician should look for objective signs of cognitive impairment and ask an informant (typically a relative) to help provide the history. Individuals who complain of cognitive problems have a higher than average risk of developing dementia, compared with those who have no such complaint.12, 13 On the other hand, subjective cognitive complaints could be the result of secondary gain (physicians are generally extremely reluctant to ever admit to secondary gain), or depression, or just longstanding personality traits. Those types of problems need to be carefully evaluated.
This is an especially useful diagnosis because it can serve as a benchmark against which changes, which may occur, can be assessed later on. The patient and the family should take action to avoid or delay full dementia by walking and eating well, by treating medical problems such as high blood pressure, cholesterol and diabetes, by reducing stress and getting adequate sleep. Studies have shown that several drugs slow progression to full dementia, as do various brain exercises and even vitamin supplements.
