What is mild cognitive impairment and how is it diagnosed?

What is mild cognitive impairment and how is it diagnosed?

Mike Davis’ mother died of Alzheimer’s disease in 2008. So when Mr. Davis began to notice that he was having an increasing number of “aging moments” at age 76 — such as forgetting to water his plants, something he usually paid attention to — he decided to test his perception.

After an evaluation, Mr. Davis’ doctor told him he had mild cognitive impairment.

Millions of Americans are believed to have mild cognitive impairment, although exact numbers are difficult to determine because experts say the condition is underdiagnosed. There are likely several reasons for this: It can be difficult to identify mild cognitive impairment during a primary care visit, when doctors typically only have 15 minutes or so with a patient. People may also be afraid to disclose their concerns to a doctor, or may not even realize they have a problem.

Here’s what to know about mild cognitive impairment (MCI) and how to diagnose it.

Mild cognitive impairment (MCI) most often arises from a neurodegenerative disorder, such as Alzheimer’s disease, but cognitive impairment may also be caused by a reversible problem, such as a vitamin deficiency, a sleep disorder, or medication side effects. If MCI is caused by a neurodegenerative condition, it can progress to dementia, although how long it takes varies greatly. According to the Alzheimer’s Association, about 10 to 15 percent of people with mild cognitive impairment develop dementia each year.

“Mild cognitive impairment is the stage before dementia where there are more problems with thinking than we would expect for your age,” explained Andrew Kiselica, a neuropsychologist at the University of Missouri who specializes in diagnosing dementia. “But there’s still a level of independence, where you’re not relying on other people to do day-to-day tasks.”

It can be difficult to know what is normal forgetfulness as you age and what is a sign that something might be wrong. One possible indicator of mild cognitive impairment is whether a person has to start implementing strategies to help him keep up with basic activities, Dr. Kiselica said. “They remember their medications or what shopping to buy, but they have to use a lot of to-do lists to make sure they get those things done,” he said.

Or there may be “events that tell” the forgetfulness, said Dr. Halima Amjad, an assistant professor of medicine specializing in geriatrics at Johns Hopkins University School of Medicine. Not just, “Oh, I forgot my phone.” “I forgot what I came into this room for,” which everyone experiences from time to time, she said, but “Oh my God, I had to call someone because I couldn’t find my car in the parking lot.”

Most people are first screened for mild cognitive impairment and dementia in their primary care doctor’s office. Medicare requires doctors to evaluate cognitive health at an annual well-visit, for which people are eligible starting at age 65, though these screens can be as basic as asking a patient if they’ve noticed any problems with their memory. Typically, a doctor will not begin testing for dementia longer unless the patient or family member expresses concern, Dr. Amjad said.

If you are concerned that a loved one may have memory loss and think they should be evaluated, try broaching the topic with them in a sympathetic, non-confrontational way. Dr. Kiselica recommends emphasizing that if the test is done, it is possible to prove you wrong. For example: “I’ve noticed that you’re having some memory problems, repeating yourself and forgetting things you’ve said. I could be wrong, and if we go to the doctor, they can tell us one way or another.”

If the person is resistant, you can also try calling their doctor before the next appointment to express your concerns. This puts the perception “on the doctor’s radar so the doctor can ask questions and consider doing some tests,” Dr. Amjad said.

Two commonly used cognitive tests to diagnose mild cognitive impairment and dementia are the Mini-Mental State Examination and the Montreal Cognitive Assessment. Both take about 10 minutes and include questions that assess memory, attention, verbal ability, and general awareness. For example, the doctor may ask the patient to remember a few words and retell them after several minutes, name as many animals as possible or count backwards in groups of seven.

Scores below a certain threshold are classified as MCI, followed by mild, moderate, and severe dementia. However, cut scores may not be accurate for all populations. For example, black and Latino older adults score worse, on average, than white older adults, which researchers say is likely in part due to systematic differences in educational opportunities. As a result, some experts recommend different cutoff periods based on race and ethnicity.

For Dr. Amjad, the tests are one piece of information in a bigger picture. She said that the patient’s impression of his own abilities, in addition to the account of a family member, is just as important, if not more so.

If someone is diagnosed with mild cognitive impairment, they may be referred for more comprehensive cognitive testing with a neuropsychologist, and should receive other evaluations, such as brain scans and blood tests, to determine the underlying cause of their problem.

Dr. Carolyn Fredericks, assistant professor of neurology at Yale University School of Medicine, said a diagnosis alone cannot explain the cause of a person’s symptoms. “This of course is the most important part and the one that has the most meaning for the patient in terms of, ‘How worried should we be, and what does this mean for the future?’

But the first step is to evaluate your cognitive health. If you’re concerned about your memory, “go see a doctor,” encouraged Mr. Davis, who managed mild cognitive impairment for five years by staying physically and mentally active.

“Start thinking of this as part of your physical exam,” Dr. Amjad added. Just as doctors check your heart and lungs, “this is how we can test the brain.”

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