Mild cognitive impairment (MCI) is a detectable cognitive disorder, which falls between the cracks of normal age-related memory changes and dementia.

MCI affects approximately 10-20 percent of those older than 65 and is defined by a relative decline in cognitive skills, including memory, problem solving, planning, organization or multi-tasking. However, the decline is not severe enough to impact one’s abilities to engage in the activities of daily living, such as driving a car, managing money or remembering to take medications accurately.

Dementia, in contrast, is defined by more significant cognitive symptoms, particularly those involving memory, which reduces one’s ability to remain independent in everyday functioning.

Memory experts diagnose two main types of MCI:

• Amnestic MCI: A subtype that primarily affects memory. People may forget details of conversations, recent news events or medical appointments in a way that is not typical for them.
• Non-Amnestic MCI: A subtype in which other cognitive skills decline, more so than memory, including those involving decision making, word finding, judgment, complex problem-solving or attention span.

A Controversial Diagnosis
Since first being labeled a diagnosis in 1999 at the Mayo Clinic in Rochester, New York, MCI has been somewhat controversial. To this day, researchers debate whether MCI is a stable cognitive diagnosis that will not change over time or the very early stages of dementia. Studies show that 10-15 percent of patients with MCI progress to Alzheimer’s disease each year, compared to a rate of 1-2 percent a year for the older adult population. However, not all people with MCI decline, and some even improve when contributory factors for the cognitive change are identified and treated. Factors associated with a higher likelihood of a conversion from MCI to Alzheimer’s disease include confirmation of new onset changes in memory or thinking by someone who knows the person well and significant decline in the person’s interest in previously enjoyed activities or hobbies.

Risk Factors
Risk factors for MCI are the same as those for all dementia: increasing age, a family history of dementia, including Alzheimer’s disease, and medical conditions that raise the risk of cardiovascular disease, including diabetes, hypertension and sleep apnea, particularly when left untreated. Depression has also been shown to be predictive of progression from MCI to Alzheimer’s disease.

Treatment
There are no medications approved by the U.S. Food and Drug Administration to treat MCI. While research results are mixed, drugs approved to treat symptoms of Alzheimer’s disease such as donepezil (Aricept) have not shown any lasting benefit in delaying or preventing progression of MCI to dementia.
In the absence of medications, research tells us that the best way to counter cognitive decline is by optimally controlling any cardiovascular risk factors you may have, particularly hypertension and diabetes. This means taking your medications exactly as prescribed and engaging in consistent, safe exercise to nourish the blood vessels throughout your body, including those vital for brain function.
Make sure to speak with your doctor about any drugs you may be taking that are known to impair memory, especially in older adults, particularly over-the-counter sleep aids  like Benadryl, Tylenol PM and Advil PM. Cognitive exercise- actively trying to compensate for any cognitive changes-and remaining socially engaged are important, too.

What to do if you are concerned?
A neuropsychological evaluation is the gold standard to determine if a person meets criteria for a diagnosis of MCI or any cognitive disorder, including dementia. This type of evaluation allows for an objective assessment of cognition and for the provider to take into account all possible explanations for a change in functioning or behavior.  Recommendations can then be personalized, offering the best chance for either improvement or stabilization of cognitive symptoms. Normal performance on cognitive testing can be reassuring, at least for the next couple of years. Memory researchers recommend that a person diagnosed with MCI be re-evaluated every six to nine months to determine if symptoms are staying the same, improving or getting worse.