What Does It Mean to Receive a Diagnosis of Mild Cognitive Impairment?
Some changes in memory and thinking skills are frustrating, though normal, aspects of getting older. However, if you experience changes that go beyond what is typical for your age, you may be diagnosed with mild cognitive impairment (MCI).
In simplest terms, MCI represents a stage between expected declines in memory,judgment, language or other brain functions and severe declines associated with dementia. “MCI is a clinical diagnosis to capture a stage of cognitive impairment where there are objective differences or worsening in cognition that are a modest decline from one’s baseline level,” explains Massachusetts General Hospital psychiatrist Jennifer Gatchel, MD, PhD. “Despite thesechanges, which are detected on tests of memory or thinking, one is still able to function independently in daily activities, though more support is generally needed.”
In other words, you may be able to retain a great degree of independence with MCI, though assistance with finances, reminders about appointments, and help in other areas may be necessary moving forward. For some people, family members and friends can provide sufficient support. Other individuals may benefit from home health aides or similar caregiving assistance.
Who Is Affected by MCI?
An estimated 10 to 20 percent of people over the age of 65 have MCI, though getting a solid estimate is difficult, because most health experts agree it’s an underdiagnosed condition. Of the individuals diagnosed with MCI, about 10 to 15 percent go on to develop dementia each year.
Although advancing age is the primary risk factor for MCI, there are others. Conditions such as diabetes, depression, and stroke may affect your risk. MCI may also be the result of medication side effects, a blood clot or tumor in the brain, excessive alcohol consumption, a head injury, emotional difficulties, or other physical or mental health conditions.
“Depending on the cause of the clinical syndrome of MCI, an individual may remain stable, improve in cognition (meet the criteria for normal cognition on repeat testing), or progress to dementia,” Dr. Gatchel says. She adds that Alzheimer’s disease (AD) is the cause of around 60 percent of cases in which MCI occurs alongside notable changes in memory. Other cases may be due to mixed etiologies or non-AD etiologies.
The course of MCI depends not just on its cause, but a person’s overall health and the presence of other health concerns. “If MCI is due to an underlying neurodegenerative disease, such as Alzheimer’s disease, an individual may experience a slow insidious decline over several years,” Dr. Gatchel says. “This decline can be hastened by medical, neurological, or psychiatric comorbidities. If MCI is a manifestation of vascular disease, decline may occur in a series of abrupt steps.”
Dr. Gatchel emphasizes that if the MCI is related to reversible or partially reversible medical or psychiatric abnormalities, rather than neurodegenerative etiologies, an individual may remain stable or even improve over time if these conditions are addressed.
After the Diagnosis
If you or a loved one receive an MCI diagnosis, your first question may be, “What now?” Dr. Gatchel says that it may be appropriate to investigate further what might be causing cognitive impairment and seek treatment if necessary.
“It is important to remember that this is a clinical diagnosis, and it alone doesn’t mean one has Alzheimer’s disease, vascular disease, or other conditions,” she says. “However, it means that further testing would be beneficial to diagnosis the etiology or cause of the MCI, so that appropriate interventions and life planning can take place.”
She notes that not all, but many, cases of MCI with memory-related changes can be due to Alzheimer’s disease. “Even if this is the case, making this diagnosis early is important, as there are now diseasemodifying therapies and other interventions—and more on the horizon—that are available that can slow the path of further decline. It’s important to remember that there are things one can do. If the MCI is due to a non-neurodegenerative process, recognizing this and addressing it can result in stability or evenimprovement.”
Regardless of its cause, MCI also should be viewed as a signal to address matters such as advanced directives and any financial or familial concerns that may not be possible if there is further cognitive decline later on.
“It is always a good idea to get advanced directives and financial power of attorneys in place according to one’s wishes when one is capable of planning and conversing with family and counsel,” Dr. Gatchel says. “This not only applies for MCI, but really for everyone. Advanced directives and health-care proxy designations are important to get into place because they allow you to document the choices you would like for your future medical care, and to designate a surrogate or surrogates to make medical decisions for you when you lose this ability. This is important, as it can help you communicate your wishes so that they are carried out. It is also important to think about career transitions and management of other higher-risk assets that may be best to transition out of.”
This may also be the time to record family histories, messages to loved ones, and other information that is important to preserve. Think about having some important conversations, even if they are difficult ones, with people you love and people with whom you’d like to reconnect or mend fences.
© MoMo Productions | Getty Images Relying on a home health aide is one way to accommodate for changes in brain functions related to MCI. You may be able to live independently for some time, but with the occasional help of others to make sure you take your medications as directed and manage other responsibilities.
Takeaway
While an MCI diagnosis can be a devastating blow, it is also an opportunity. You can pursue further testing and screenings to learn more about your condition. There are a few different types of MCI, and each one impacts brain function a little differently.
You can use this news as a way to start addressing matters that you might have been putting off for a long time. For some people, a diagnosis of MCI is a reminder to make the most of your time while you are still able to share stories, make important decisions, and appreciate little things that often get overlooked in the rush of our daily routines.
If you are caring for someone with MCI, you can use this diagnosis as a stepping-off point to learn more about the condition and how you can best look out for someone who may need you now more than ever.
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