Mild Cognitive Impairment and Dementia: Early Signs and Evaluation

Overview

This page is educational. It cannot tell you whether you or someone you love has a condition; only an evaluation can. Evidence labels used: established recommendation, promising but limited, mixed, insufficient evidence, preclinical (animal or lab only).

Mild cognitive impairment (MCI) means a person has more memory or thinking problems than other people their age, but can still take care of themselves and do normal daily activities. [1]

Dementia is not one disease. It is a group of symptoms caused by damage to the brain from different diseases, such as Alzheimer's disease, and it is not a natural part of ageing. [2] Alzheimer's is the most common cause; vascular dementia is the second most common. [2]

Early changes worth a check

Early symptoms that can appear before a dementia diagnosis include memory loss, difficulty concentrating, trouble with familiar tasks such as working out change when shopping, struggling to follow a conversation or find the right word, confusion about time and place, and mood changes. These are often mild and may worsen only very gradually. [2] With MCI, signs can include losing things often, forgetting events or appointments, and having more trouble finding words than peers. [1]

Many other things cause similar changes, including depression, anxiety, delirium from infection, an underactive thyroid and some medicines. [3] See forgetfulness and memory loss and when to get help.

How evaluation works

A doctor asks about symptoms and everyday function, examines you, may order blood and urine tests, and gives a memory or thinking test. A referral to a memory specialist, with scans, may follow. [3] The American Academy of Neurology guideline says clinicians should assess for MCI with validated tools, look for modifiable risk factors, check for functional impairment, monitor over time, and discontinue cognitively impairing medicines where possible. [4] The NIA suggests seeing a doctor every six to 12 months with MCI to track changes. [1]

What happens over time

Not everyone with MCI develops dementia. The NIA estimates that 10 to 20% of people aged 65 or older with MCI develop dementia over a one-year period, and in many cases symptoms stay the same or even improve. [1] The AAN guideline reported a cumulative dementia incidence of 14.9% over two years in people with MCI older than 65. [4] If an underlying illness such as depression, anxiety or thyroid problems is treated, symptoms often go away. [5]

Care at overview level

• MCI: There is no standard treatment or approved medication for MCI. [1] The AAN found no high-quality evidence for drug treatments, said exercise training (6 months) is likely to improve cognitive measures, and said cognitive training may. [4]
• Alzheimer's disease: There is no cure, but medicines can relieve some symptoms, and support and psychological treatments such as cognitive stimulation therapy may be offered. [6]
• Planning: A diagnosis gives people time to prepare for the future and access support. [3]

What about prevention?

No one can promise prevention. The NIA says nothing has been proven to prevent Alzheimer's, though researchers have identified promising strategies. [7]

The Commission's 14 factors are low education, hearing loss, high blood pressure, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol use, traumatic brain injury, air pollution, social isolation, high LDL cholesterol and untreated vision loss. [11] Managing these supports general health too. See brain-healthy habits and nootropics and memory supplements.