Mild Cognitive Impairment – What to Do?

Mild cognitive impairment, or MCI, is a sort of half-way house between the normal cognitive decline seen as one ages and the far more severe Alzheimer’s. There’s no definitive test that distinguishes it from normal cognitive decline, whereas it’s by no means clear where MCI fits within the well-accepted 7 stages of Alzheimer’s disease. In the Mayo Clinic description of Alzheimer’s progression, which has 3 stages, MCI is clearly less disruptive than the lowest, or ‘mild stage’ of Alzheimer’s.  

What’s the prognosis for someone diagnosed with MCI? The diagnosis really represents a risk group; some members will develop dementia, but a substantial number will not. A large study from Germany found that 60-65% of people with MCI at age 75 will develop clinical dementia during their remaining lifetime; the onset is usually seen within 18 months of the MCI diagnosis.

This gloomy prognosis indicates that MCI is a condition crying out for treatment. However, trials of current medications for preventing progression to dementia have been largely negative. It’s likely that lifestyle modifications, including exercise, leisure activities, cognitive stimulation, and social activities, can be effective for prevention of MCI progression.

A recent publication in the Journal of Neurology, Neurosurgery, and Psychiatry describes the use of “an early cognitive intervention” in people with mild cognitive impairment. Fifty-two MCI patients, together with their family partners, were randomly allocated to the cognitive intervention (memory rehabilitation) group or to a waitlist (the control group). They were assessed at 2 weeks’ and 4 months’ follow-up using measures of prospective, or everyday, memory, and memory strategies. Everyday memory significantly improved after the cognitive intervention, along with use of memory strategies; this was also noted by the family members.

There are a number of new drugs in development for treating or slowing Alzheimer’s. Trials of these, as well as cognitive intervention or rehabilitation approaches, are obviously needed, to try to head off the almost inevitable deterioration seen with MCI.