Understanding and diagnosing mild cognitive impairment (MCI)

The proverbial elephant in the room is the topic of memory loss when older adults visit their doctor. But like most challenging issues, ignoring the subject will not make the problem go away. The importance of distinguishing normal signs of aging from symptoms of dementia are emphasized in Normal Aging: Understanding Mild Cognitive Impairment, a supplement to the Alzheimer’s Association’s 2022 Alzheimer’s Disease Facts and Figures report.

Is it aging or something more?
At age 60 or older, it is not unusual to experience symptoms that suggest changes in cognition. Symptoms of mild cognitive impairment (MCI) may include forgetting conversations, misplacing items, losing train of thought, losing the way to a familiar place, or feeling overwhelmed when making decisions. Finding out if these changes are precursors to something in need of further examination requires taking charge of our brain health. Surveys by the Alzheimer’s Association found that 80 percent of people in the United States know little or nothing about MCI. When given a description of the signs of MCI, more than half of people thought they were simply the pitfalls of aging. But when MCI due to Alzheimer’s disease is described, almost half of people express concern.

Take charge of your brain health
When symptoms of MCI first occur, it is important see a physician who can determine what factors are at play. Medication side effects, sleep deprivation, and anxiety are known causes of MCI that can be lessened or stopped when changes are made. It is also important to identify other possible causes of memory loss including brain injury, stroke and other vascular diseases.
One-third of people with MCI will develop dementia within five years, and improving the ability to distinguish MCI from normal aging is a goal of current medical research. Early detection presents the best opportunity for management and treatment, allowing individuals the ability to plan for the future, make lifestyle changes that may slow disease progression, and enjoy a higher quality of life for as long as possible. Early and accurate diagnosis will become more urgent as new treatments enter the market.

See something, say something
Raising public awareness about MCI and improving rates of early diagnosis are ongoing efforts of the Alzheimer’s Association. Seventy percent of American say they would talk to someone if they notice symptoms of MCI, but only four in 10 report they would talk to their physician right away. Unfortunately, waiting until symptoms worsen or until others express concern is a common.

Know your cognitive status
Tell your primary care physician that you want a medical assessment of your cognitive health. He or she will review your medical history, conduct a patient questionnaire, provide a clinical exam and assess your thinking and memory function. “Reasons to undergo testing for mild cognitive impairment include ruling out reversible causes, obtaining a correct diagnosis and taking measures to change risk factors such as diet,” according to Julia Biernot, M.D., neurologist and assistant professor at the University of Maryland School of Medicine. “Because the majority of cases of mild cognitive impairment can be caused by Alzheimer’s disease changes, obtaining a diagnosis is important for future planning and seeking out possible clinical trials.”
While the Alzheimer’s Association’s report underscores the need for a more robust effort to raise public awareness about MCI, the most effective approach requires a joint effort. When patients inform their primary care physician of symptoms of MCI and cognitive tests are administered, the result is early intervention with improved outcomes.
--Ilene Rosenthal is the Program Director for the Alzheimer’s Association Greater Maryland