Mild Cognitive Impairment (MCI)

Mild Cognitive Impairment (MCI) means memory or similar problems that are not severe enough to be called Dementia.  For example, a person may have some memory loss as documented on memory testing, but functions well in life.  Or someone may have behavior changes, like depression, irritability, anxiety, even strange thoughts or delusions, but memory testing is normal (see topic Memory Loss).

About 15% of people over 70-year-old might meet this definition of MCI, which is sometimes called “age-related memory impairment.”  As opposed to Alzheimer’s Disease, where patients aren’t aware of their condition, persons with MCI are.  About 10% will progress to actual Alzheimer’s Disease each year for the next 3-5 years, then the danger is less so.  But up to a third patients diagnosed with MCI may get better.

There’s no treatment for MCI, either to improve it, or to prevent worsening.  The main question is, who will go on to get Alzheimer’s.  Various tests can help determine this, such as an MRI, a PET scan (to measure if the brain is using glucose and oxygen as it should), and blood tests for a gene Apolipoprotein E epsilon 4 (ApoE ฮต4).  But none of these are perfect, even when theyโ€™re done in combination.  Before ordering anything, clinicians need to have a deep discussion with the patient — as to whether they want information suggesting, not proving, that they may develop Alzheimer’s, or would they rather wait to see what plays out in the future.

The most important treatment is to seriously control risk factors for Vascular Dementia, which is caused by Strokes (either large or tiny).  The main risks are Hypertension, Diabetes, High Cholesterol, and Smoking.

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