Mild Cognitive Impairment (MCI)

Overview

We know that some memory loss is associated with getting older. We forget someone’s name, where we put the keys, the date. But if memory loss is becoming troublesome, and you notice that it’s happening more and more, you may have what’s known as mild cognitive impairment (MCI).

This fact sheet provides information about MCI, practical tips for coping with its effects, and suggestions for how family members or friends can help.

Facts About Mild Cognitive Impairment

Mild cognitive impairment is a condition that falls somewhere between normal age-related memory loss and Alzheimer’s disease or a similar impairment. Not everyone with MCI develops dementia. And like dementia, MCI is not an illness, but a cluster of symptoms that describes changes in how you think or process information. Memory problems are the most common indicators of MCI. A person with MCI may also experience difficulties with judgment, thinking, and language beyond what one might expect with normal aging. For unknown reasons, MCI appears to affect men more than women.

Family members and friends who notice these problems might not express concern because the early symptoms can mimic normal, age-related changes. People suffering from MCI often recognize they are having trouble but are still able to carry on most of their usual activities and live independently.

Symptoms of MCI

If you or your family members have increasing concerns about your mental abilities and memory, the cause could be MCI. If so, you will be experiencing some or all of the symptoms below:

• More frequent difficulty remembering simple things
• Difficulty following a conversation or basic instructions
• Frequently losing your train of thought
• Forgetting appointments or scheduled events
• Feeling overwhelmed when you attempt to make plans or decisions
• Losing your way even in familiar locations.

With MCI, these changes do not occur suddenly but worsen over time. In addition to these cognitive symptoms (or perhaps because of them), many people with MCI also experience secondary emotional symptoms such as depression, anxiety, irritability, or apathy.

Causes of MCI

The causes of MCI are not clear, but it appears that some of the same risks for Alzheimer’s disease are risks for MCI. Those risks include:

• Being 65 or older
• Having a family history of MCI, Alzheimer’s disease, or another form of dementia
• Having certain medical conditions, such as high blood pressure, diabetes, stroke, high cholesterol, or heart disease
• Substance abuse, including alcohol abuse
• Lack of exercise

Brain imaging and medical research have shown that some people with MCI also have the plaques, neurofibrillary tangles, and shrinkage in the memory center of the brain that is observed in those with Alzheimer’s disease (AD).

Other problems (which may be reversible) can contribute to memory loss, including medication interactions (from both presciption and over-the-counter drugs), infections, vitamin shortages, malnutrition, thyroid and other metabolic disturbances, depression, and drug/alcohol abuse.

It’s important to note that some people with MCI never get worse, and do not develop Alzheimer’s. Current studies find that approximately half of the people diagnosed with MCI will experience continued progression of the symptoms, leading to a diagnosis of Alzheimer’s disease or a similar dementia.

Diagnosis and Treatment

There is no single, specific test to indicate the presence of MCI. A full evaluation is necessary to diagnose MCI and/or rule out other potential causes of the symptoms.

This thorough evaluation, similar to that for Alzheimer’s disease, includes a physical examination, neurological examinations, laboratory tests, neuropsychological and memory tests, review of medical history and medications, and clinical observations. The experiences of the patient and close friends or family members are also important to the evaluation process.

Just as there is no single definitive test, there is no specific treatment or cure for MCI. Some doctors recommend taking medications currently prescribed for early-stage or moderate Alzheimer’s disease to try to maintain cognitive abilities with MCI, but research studies have not provided clear-cut evidence on the benefits. However, new medications are being developed and studied and may be approved by the FDA. They may be restricted to people in early stages of dementia or only available for those participating in clinical trials. A neurologist can help determine if these are appropriate and to evaluate the risks and benefits.

Mental stimulation and physical exercise keep your mind and body functioning well. Health professionals theorize that what’s good for the heart is also good for the brain. One study suggests that simply walking five to six miles per week helps retain cognitive abilities or even slows down the progression of MCI.

Coping with MCI

Mild cognitive impairment can make you feel frustrated. To cope with the frustration, try some of the techniques listed below to help compensate for any memory decline that interferes with your enjoyment of life, your effectiveness at work, your relationships, and your goals for the future.

• Be patient with yourself and ask your family to be patient with you. Understand that you may feel frustrated, anxious, or sad at the loss of some abilities. Slowing down can sometimes make it easier to remember or complete a task.
• Learn more about MCI and share that knowledge with those around you. This will enable them to bet­ter understand the changes that are affecting you.
• Discuss with a family member, or other trusted person, your preferences for decisions affecting your life, should the MCI progress to dementia. (For more information on discussing your preferences, see the FCA Fact Sheets Making Choices About Everyday Care and Legal Issues in Planning for Incapacity, listed under the Resources section of this fact sheet.)
• Find constructive ways to release anger and frustration you may feel. Exercise, talk with a close friend or a counselor, and consider joining a support group for people with memory loss. (The Alzheimer’s Association has support groups for people with early stage Alzheimer’s disease, including people with an MCI diagnosis.) It will help to talk to others going through the same experience, or one that is similar. Encourage your family members to seek out counseling and support to meet their needs.
• Continue to explore ways to fulfill your needs for intimacy and closeness. Participate in family events as you are able, and keep in touch with friends. The desire for close relationships with others continues throughout life.
• Ask your physician for an exercise program that best fits your needs. Exercise contributes to good physical health, can reduce stress, and helps keep your brain as healthy as possible.
• Use visible and/or accessible reminders. Useful strategies include writing notes to yourself, posting a large calendar to track appointments, leaving messages to yourself on your answering machine, using an automatic dispensing pill box, and setting the alarm on a mobile device to remind you of upcoming events.
• Document your personal story by creating a scrapbook, recording your autobiography, or keeping a journal. This is a wonderful way to reflect upon your life and share yourself with those close to you. Your children and grandchildren will treasure these keepsakes.
• Keep your mind active doing things that you enjoy: Work on puzzles, read the newspaper, play cards, listen to music, write in a journal, learn about something new.
• Know that you are more than someone with MCI. Celebrate the many and varied personal attributes that you possess.
• Increase your awareness of MCI research projects and clinical trials of new medications. Participate in medication trials if your physician thinks they might be helpful.
• Become an advocate for yourself and other individuals with MCI. Write letters and make phone calls to local and state representatives, and assist community agencies in training staff and professionals about MCI.
• Complete an Advance Healthcare Directive, a Durable Power of Attorney, and Durable Power of Attorney for Finances. These documents will help your loved ones provide you with the type of care you want and need in the future should you be unable to state those preferences. Meet with a lawyer knowledgeable about estate planning to draft a will, set up a trust, or handle other related legal matters.
• Focus on your present abilities and avoid worrying about what might happen in the future. Know that there are many ways to live an active and productive life. Focus on what you can do, not on what you can’t.

Here are some additional tips to help you enhance your memory, health, and well-being:

• Take good care of your body. Keep hydrated by drinking plenty of water. Eat a low-fat, healthy diet, with plenty of fruits and vegetables.
• Maintain an updated list of your medications and contact information (doctors and family). Keep it with you at all times.
• Reduce clutter at home; enlist a friend to help organize and label important files, documents, and medications.
• Decrease your consumption of alcohol; it can have a negative effect on your mental abilities.
• Don’t smoke.
• Continue to engage in social activities with friends and family.
• Never stop learning. Read a book, enroll in a class, attend a concert or play.
• Talk with friends or a trained counselor about your feelings.

Transitions

It may be necessary to change your daily routine due to MCI. Although a time may come when you must rely more on others for assistance with some tasks, you will want to stay involved in making decisions that affect your life. The goal is to find a balance in your life: ensuring your safety while maintaining a reasonable degree of independence.

The following may require adjustments in your life:

• Driving: If you drive, ongoing evaluation of your driving abilities and consultation with your physician are essential. It’s also wise to pay attention to the suggestions of those close to you, as they might recognize changes in your driving ability before you do. AARP offers driving classes and evaluations of driving ability.
• Home responsibilities: Household management may be difficult for you. Tasks such as cooking and taking medications may pose safety risks. You might, for example, forget to turn off the stove or forget to take a dose of medication. However, it’s possible to continue to participate in household activities with a little help from another person or with the aid of technology (electronic medication reminders, etc.). You might choose to have family or friends assist in certain areas, or you might hire outside help. This is a good time to start discussing options with those close to you should you no longer be able to manage these tasks in the future.
• Financial responsibilities: Complex tasks like balancing a checkbook, dealing with insurance, and paying bills may become frustrating and overwhelming. Consider enlisting a trusted family member or friend to help. Work with an attorney to draw up a Power of Attorney for Finances. This will allow a trusted person to act on your behalf if you aren’t able to do so. Be sure to include this person early in the process so that he or she has time to learn what needs to be done. Like driving, managing your own finances is a sign of independence. It can be difficult to allow someone else to do this for you, but there is no embarrassment in admitting you need help. The people who are close to you may recognize your need for help before you do.
• Health care: Complete an Advance Health Care Directive (sometimes known as a Durable Power of Attorney for Health Care or a Living Will), to ensure that your family members know your health care choices. It is important to have a conversation about end-of-life care as well, and to complete the appropriate forms documenting your preferences.

Key Community Resources

The Eldercare Locator is a free service that will connect you with your local Area Agency on Aging or other sources of help.

Family Caregiver Alliance’s National Center on Caregiving (800-445-8106, www.caregiver.org) offers help in locating services in your community. If either you or your family resides in California, you will find help through your local Caregiver Resource Center by calling (800) 445-8106. Major health systems such as Kaiser Permanente often offer information and support. Diagnostic centers are also valuable sources of support.

A new diagnosis of MCI for yourself or a loved one can be difficult to accept. As you learn more about this condition, we encourage you to keep an open mind and remember that you are not alone. Speaking with other people who have had similar experiences can be immensely helpful. Organizations that provide assistance and support are located in communities all across the nation, and many websites offer information and opportunities for interaction with others in the same situation. Reaching out for help and support can make all the difference.

• Alzheimer’s, senior service, and health organizations: Several organizations, both local and national, help people with cognitive impairment or dementia and their family caregivers. Many offer support groups, advice lines, and services at no cost to you. See the Resources list at the end of this fact sheet for specific contact information.
• Support groups and counseling services: Support groups for those with memory loss can be primarily discussion-oriented or can offer a variety of creative activities including planned outings. Caregiver support groups and education programs are also available in the community for family members or friends who are assisting you.
• Volunteer programs: Volunteer opportunities for persons with MCI are available in some areas. You may enjoy the chance to contribute your time and talent to your community.
• Artistic programs: Expressing yourself through drawing, painting, clay, or photography, for example, can be beneficial and provide you wonderful opportunities for self-expression.
• Structured day programs: Adult day programs include activities such as art, music, gardening, exercise, discussion groups, field trips, and assistance with physical health needs.
• Professional assistance: Take advantage of professionals who assist with maintaining your physical strength and coordination, such as personal trainers, occupational therapists, and physical therapists. Hired attendants can also help with household chores and errands.
• Legal and financial assistance: Again, drawing up an Advanced Health Care Directive and a Durable Power of Attorney for Finances are essential first steps. The Area Agency on Aging has a listing of free and low-cost legal services for seniors in your community. For more information, see FCA’s Fact Sheet Legal Planning for Incapacity.
• Care management: A care manager experienced in the field of dementia can provide education, assistance with transitions, emotional support, and guidance in locating and coordinating community resources.

Resources

Family Caregiver Alliance
National Center on Caregiving
(415) 434-3388 | (800) 445-8106
Website: www.caregiver.org
Email: info@caregiver.org
FCA CareNav: https://fca.cacrc.org/login
Services by State: https://www.caregiver.org/connecting-caregivers/services-by-state/

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy. Through its National Center on Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers, as well as a toll-free call center for family caregivers and professionals nationwide. For San Francisco Bay Area residents, FCA provides direct family support services for caregivers of those with Alzheimer’s disease, stroke, ALS, head injury, Parkinson’s and other debilitating brain disorders that strike adults.

FCA Fact and Tip Sheets

A listing of all facts and tips are available online at www.caregiver.org/fact-sheets.

Other Organizations and Links

Alzheimer’s Association
www.alz.org

Alzheimer’s Disease Education and Referral
Center (ADEAR)
www.nia.nih.gov

BrightFocus Foundation
www.brightfocus.org

Eldercare Locator
eldercare.acl.gov

Suggested Reading

Mild Cognitive Impairment (MCI), Mayo Clinic. www.mayoclinic.com

Mild Cognitive Impairment (MCI), UCSF Memory and Aging Center. www.memory.ucsf.edu

This fact sheet was prepared by Family Caregiver Alliance and reviewed by Daniel Kuhn, M.S.W., Education Director, Mather Institute on Aging, Mather LifeWays, and by Cynthia Barton, R.N., M.S.N., Memory and Aging Center, University of California San Francisco. © 2016-2020 Family Caregiver Alliance. All rights reserved.