What is mild cognitive impairment and how is it diagnosed?

Mike Davis' mother died of Alzheimer's disease in 2008. So when Mr. Davis started noticing that at age 76 he was having more and more “senior moments” — like forgetting to water his plants, something he was normally disciplined about — he decided to have his cognition tested.

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

Millions of Americans They are thought to have MCI, although exact figures are difficult to pin down as experts say the condition is underdiagnosed. There are likely several reasons for this: MCI can be difficult to identify during a primary care visit, when doctors typically only have about 15 minutes with a patient. People may also be afraid to mention their concerns to a doctor, or may not even realize they have a problem.

Here's what you need to know about what MCI is and how it's diagnosed.

What is MCI?

MCI usually results from a neurodegenerative condition, such as Alzheimer's disease, but cognitive impairment can also be caused by a reversible problem, such as Vitamin deficiency, sleep disorder or side effect of medication. If MCI is due to a neurodegenerative disorder, it can progress to dementia, although its duration varies widely. According to the Alzheimer's AssociationApproximately 10 to 15 percent of people with MCI develop dementia each year.

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

It can be difficult to determine what is normal forgetfulness as you get older, and what is a sign that something is wrong. Dr. Kiselica said one indication of possible MCI is that someone needs to start implementing strategies to help them keep up with basic activities. “They remember their medications or what to buy when they go grocery shopping, but they have to use a lot more to-do lists to make sure they get those things done,” he said.

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

How is the diagnosis made?

Most people are first screened for MCI and dementia in their primary care physician's office. Medicare requires doctors to assess cognitive health during the annual wellness visit, which people over age 65 are eligible for, although those screens can be as simple as asking the patient if they've noticed any problems with their memory. Normally, a doctor will initiate a longer dementia test only if the patient or a family member has expressed concern, Dr. Amjad said.

If you are concerned that a loved one has memory loss and feels it needs to be looked into, try broaching the subject with them in an empathetic and non-confrontational way. Dr. Kiselica recommends emphasizing that if tested, you may be proven wrong. For example, “I've noticed that you seem to be having some memory problems, causing you to repeat yourself and forget things I'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 the doctor before an upcoming appointment to express your concerns. That puts cognition “on the doctor's radar, so the doctor can ask, think about doing some tests,” said Dr. Amjad.

Two commonly used cognitive tests to diagnose MCI and dementia are the Mini-mental state exam and the Montreal cognitive assessment. Both last approximately 10 minutes and include questions assessing memory, attention, verbal skills and general awareness. For example, the doctor can ask the patient to remember a few words and repeat them a few minutes later, 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, the cutoff scores may not be accurate for the entire population. For example, Black And Spanish Older adults, on average, score worse than white older adults, which researchers say is likely due in part to systemic differences in educational opportunities. As a result, some experts recommend different cutoffs based on race and ethnicity.

For Dr. Amjad, the tests are one piece of information in a larger whole. The patient's impressions of their own abilities, plus a family member's story, are just as important, if not more so, she said.

What comes next?

If someone is diagnosed with MCI, they may be referred for more extensive cognitive testing with a neuropsychologist, as well as other tests, such as brain scans and blood tests, to determine what the underlying cause of the problem may be.

A diagnosis alone can't explain what's behind a person's symptoms, said Dr. Carolyn Fredericks, an assistant professor of neurology at the Yale School of Medicine. “And that's obviously the most important piece and the piece that has the most meaning for the patient in terms of, 'How concerned should we be and what does this mean for the future?'”

But the first step is to get your cognitive health evaluated. If you're concerned about your memory, “Go to a doctor,” encouraged Mr. Davis, who has managed his MCI for five years by staying physically and mentally active.

“Start thinking about this as part of the physical exam,” Dr. Amjad added. Just as doctors check your heart and lungs, “this is a way for us to test the brain.”