80% of Americans don't know what Mild Cognitive Impairment Is
Whenever I would gently suggest to my mother that maybe she was having memory problems she became like a cornered animal, lashing out that I was cruel, ungrateful and likely plotting to put her in a nursing home. Those conversations tended to be short. When my dad was annoyed with my mother he would mention that he was worried about my mother’s memory. He said it so frequently and in the exact same way such that it was suggestive of his own memory problems. Whether this was deflection, projection or genuine concern I’ll never know.
Everyone I know who is over 40 is hyper aware of memory problems. There is a lot of nervous joking among my peers that their own forgetting is a sign of dementia. This same group does a lot of sighing and expressing dread when talking about their parents/aunts/uncles emerging memory problems.
If you suspect your senior is having memory problems you are probably right. I think there is some hesitation to tackle this subject because of our collective anxiety about its implications. Everyone is worried about the same thing: dementia. *Cue catastrophic rabbit hole thinking in which you envision yourself or your loved one drooling in a nursing home sitting in a dirty diaper for days on end.
We are here to let you know that not all memory problems are a result of dementia. Many memory problems are due to a lesser known condition called mild cognitive impairment, or MCI. This is an in-between stage when cognition is not quite normal but it is not yet dementia. Notably, not all MCI turns into dementia and sometimes it even improves.
You know how you can sometimes tell when people are upset without them telling you? If a spouse is irritated maybe they get quiet or rage clean. Teens might shut down and spend more time in their rooms. Mild cognitive impairment is like this too; subtle but noticeable to loved ones seniors spend time with. Like many things, to the person experiencing cognitive changes, if they stop and think, and are emotionally open to this, they will recognize the changes also. With this condition things are off but then also things are fine. People with MCI are still traveling, still driving, still volunteering and living on their own largely without problems.
The best explanation of the difference between MCI and dementia hails from Dr Jason Karlawish of the Univeristy of Pennsylvania Memory Center. He notes that:
Mild Cognitive Impairment causes inefficiencies
Dementia causes disabilities
I think this is so helpful for people trying to understand the difference. People with MCI can still function very well in their daily lives. Some people with MCI are still working. They are still paying bills but may be making mistakes like forgetting to pay or paying twice. They are still shopping and cooking but might struggle in a store they are not familiar with. They might mess up recipes or cooking techniques they are familiar with. People with MCI make mistakes but they discover the mistakes and fix them. They are often frustrated with these mistakes.
With dementia there is disability. People cannot reliably function well on their own. Sure they may sometimes be able to remember they have meds to take or know that a bill needs to be paid but this is not the norm. People with dementia lose things and cannot find them. They cannot learn new things. You see this a lot when there is a new iPad or a new digital photo frame and they cannot figure it out.
How Common is It?
Roughly 12% to 18% of people over age 60 are living with MCI. According to the American Academy of Neurology, the incidence of MCI is as follows:
Age 60 to 64 years: 6.7%
Age 65 to 69 years: 8.4%
Age 70-74 years: 10.1%
Age 75-79 years: 14.8%
Age 80-84 years: 25.2 %
Does MCI always lead to dementia?
Not necessarily. It depends on the cause of your cognitive impairment. If Alzheimer’s disease is the cause of the MCI then about a third of these cases will progress to dementia within 5 years. 10% to 15% of people with MCI will develop dementia each year.
Some medications can cause MCI. Benzodiazepines (like Xanax), incontinence medications, antihistamines (like Benadryl), seizure medications are all common culprits. It is not as simple as just stopping the medication so be sure to talk with your senior’s doctor if you are concerned.
Significant or untreated anxiety and depression can also cause cognitive problems. So can regular and excessive alcohol or marijuana use. Hearing loss can worsen cognition also.
What should you do if you suspect your senior is having memory or cognitive problems?
How you approach this discussion will often depend on how willing your senior is or has been in the past to have difficult conversations. You know your relationship best but I generally think a serious topic warrants a devoted conversation, not something on the fly or with joking.
It can be helpful to ask permission to share some things you have noticed about their health and memory. If your senior is open to this discussion, congratulations. It is seriously a huge win. Offering to help your senior figure out if something is going on can be helpful. It is scary to navigate a health problem on your best day. Doing it with a support person can make all the difference.
If your senior turns you down that is also good information to have and you will need to try again in a different way. If all attempts fail then I would strongly recommend reaching out to your senior’s doctor. Please see my blog post for specific recommendations about how to do this. Even if your conversation with the doctor goes nowhere it is on the doctor’s radar. If a family member suspects a cognitive problem with one of my patients, I take it seriously. Diagnosing these things can sometimes take time, especially if a senior is unwilling to address the problems their family is seeing. I always tell families “you didn’t get to this place overnight so it’s gonna take some time to untangle it all”
What do you do if you have MCI? Can you treat it?
First you have to figure out if your senior is having cognitive impairment. Most primary care providers are very comfortable with a workup for cognitive impairment.
Commonly, healthcare providers will order more testing when cognitive problems are suspected. Usually there is an in office screening. Frequently blood work is ordered. Sometimes brain imaging like a CT scan or MRI is ordered to try to figure out if mini strokes or some other vascular problem is the cause. In some cases, seniors will be referred for neuropsychological testing. This is a longer assessment with a psychologist who specializes in figuring out tricky brain and memory problems.
There is no FDA approved medication for MCI. If there is an underlying condition like a sleep disorder or depression then treating that condition should improve the cognitive changes. Some people with memory problems will have memory medications prescribed but this is not routine.
If your senior is diagnosed with MCI there is a lot you can do to try to prevent it from progressing. Your senior’s doctor should be able to give you recommendations tailored to your senior but in general here are some things to address:
Make sure blood pressure is well controlled
Correcting hearing and vision loss will help slow the progression of cognitive decline
Making sure there is no underlying sleep disorder like sleep apnea
Avoid alcohol use
Exercise regularly a few days per week
Avoid social isolation- stay engaged with family and friends whenever possible
Participate in challenging brain activities like reading, puzzles, games
Understanding that memory issues are a nuanced problem and aren’t always a sign of dementia can help decrease the stigma. And decreasing the stigma will lessen the fear around admitting there is a problem! Fear is usually what is at the root of the resistance. Denial, anger and frustration makes discussing cognitive issues with seniors challenging. Remind yourself and your senior that It can be caused by lots of things, and can even improve in some cases.
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