Deep Dive: What is mild cognitive impairment?

What is MCI?

Mild cognitive impairment: It sounds harmless enough, but hearing these words at the doctor’s office can send a patient into a tailspin in search for what exactly that means for their brain health.

Mild cognitive impairment, also known as MCI, is not a disease itself; rather, it’s a way to describe brain health and performance based on a cognitive test and reported thinking skills.

What is MCI?

Mild cognitive impairment: It sounds harmless enough, but hearing these words at the doctor’s office can send a patient into a tailspin in search for what exactly that means for their brain health.

Mild cognitive impairment, also known as MCI, is not a disease itself; rather, it’s a way to describe brain health and performance based on a cognitive test and reported thinking skills.

"Some forgetfulness is normal... then there's mild cognitive impairment." –Oliver Baumann and Cindy Jones, brain health researchers at Bond University in Australia

Symptoms: What does MCI feel like?

If you’re struggling with what’s often referred to as “brain fog” or having other cognitive issues that don’t seem normal to you, MCI might be the cause.  Some forms of MCI only affect memory. This is called amnestic MCI. People might forget previous conversations, or misplace items like wallets and keys. In other cases, MCI affects parts of the brain that aren’t related to memory, causing difficulty with speech or language (also known as aphasia), trouble focusing, and difficulty navigating familiar spaces.

People with MCI often experience things like:

  • Frequent forgetfulness
  • Losing one’s train of thought
  • Getting lost or disoriented in familiar places
  • Having a hard time following along with a story or conversation
  • Missing appointments or social engagements
  • Difficulty with decision-making or judgment
  • Difficulty finishing tasks or following directions

MCI can also come with symptoms like uncharacteristic depression, anxiety, aggression or apathy. These same symptoms are also common in people living with Alzheimer’s or another form of dementia — but across the board, MCI’s symptoms are less severe.

If you’re noticing any of these symptoms — or if your friends or family are — it might be time to check in with a doctor. The good news: one in four of cases of mild cognitive impairment can be reversed.

“There are a lot of reasons why people have cognitive impairment. You can’t jump to the conclusion that ‘I have mild cognitive impairment, I must have Alzheimer’s disease.’” -UCLA Sidell-Kagan Alzheimer’s Disease Treatment Development Program Director Dr. Sarah Kremen

What causes MCI?

Mild cognitive impairment could be caused by a neurodegenerative disease like Alzheimer’s or another form of dementia, but it can also result from a host of other factors, from cardiovascular health issues to hormone changes to a lack of sleep.

If untreated, these other causes could also increase the risk of developing dementia. But treating these conditions may well reverse and clear up MCI. Here are a few of those possible causes.

What causes MCI?

Mild cognitive impairment could be caused by a neurodegenerative disease like Alzheimer’s or another form of dementia, but it can also result from a host of other factors, from cardiovascular health issues to hormone changes to a lack of sleep.

If untreated, these other causes could also increase the risk of developing dementia. But treating these conditions may well reverse and clear up MCI. Here are a few of those possible causes.

Sleep issues

Some people with insomnia experience MCI. Sleep deprivation prevents the brain from resting and recharging. Working with a doctor to improve sleep quality can help reverse this type of MCI. 

Depression

As many as three in five people diagnosed with depression will experience some form of memory loss or cognitive impairment. Treating the underlying depression can alleviate these symptoms.

Anxiety

Anxiety — which might feel like apprehension, fear, repetitive negative thinking — is also part of the equation. In fact, research shows it may be an early indicator of Alzheimer’s, especially when paired with MCI.

Metabolism issues

Cardiovascular disease causes the narrowing of arteries, damages blood vessels, and makes it harder to supply nutrients and oxygen to the brain. In this case, lowering blood pressure and cholesterol through exercise, dietary changes, and medications like statins may reverse MCI.  Doctors are also exploring the links between cognitive function and hyperthyroidism.

Chronic Pain

Some research shows that persistent or chronic pain that disrupts people’s ability to work and carry out chores can be linked to an increased risk of cognitive impairment. Treating chronic pain in healthy ways could help alleviate the cognitive symptoms. (Though when it comes to treatment, it’s important to remember that some medications may also lead to MCI.)

Traumatic brain injury

Traumatic brain injury and stroke can damage specific parts of the brain, leading to cognitive and memory problems. In some cases, the cognitive changes that result from TBI can be reversed through rehabilitation, depending on the severity of the injury.

Long COVID

The COVID pandemic has introduced many scientific and medical terms into our everyday language. Many of us are now fluent in conversations about viral strains, PCR tests and mortality rates. “Brain fog” has joined these ranks to describe a now-familiar symptom of COVID and long COVID, and many of its symptoms overlap with MCI.

Hormonal changes

The hormonal shifts occurring during menopause could lead to MCI — also known colloquially, in this case, as “menopause brain.” Some researchers are exploring hormone replacement therapy as an approach to reducing menopause symptoms, including cognitive impairment. 

Alzheimer’s disease

Alzheimer’s and other forms of dementia are characterized by cognitive symptoms which often include memory loss, confusion, and difficulty staying focused. MCI could be an early phase of these brain changes, according to Dr. Marwan Sabbagh, an expert in the overlap between dementia and MCI — and how doctors differentiate the two.

Is MCI reversible?

Can you improve mild cognitive impairment, or stop MCI from progressing? How do you overcome it altogether? How long does is last? Depending on the underlying cause of MCI, it may be possible to treat, stop or even entirely reverse mild cognitive impairment, and get back to one’s previous, “normal” cognition. Read more about when and how it’s possible to reverse MCI.

Is MCI reversible?

Can you improve mild cognitive impairment, or stop MCI from progressing? How do you overcome it altogether? How long does is last? Depending on the underlying cause of MCI, it may be possible to treat, stop or even entirely reverse mild cognitive impairment, and get back to one’s previous, “normal” cognition. Read more about when and how it’s possible to reverse MCI.

UCSF neurologist Emily Paolillo on what an MCI diagnosis actually means for a patient

“Lots of things can cause cognitive change, some of which are pretty normal. Age is related with a lot of declines in functioning that are pretty typical. There are other things that can cause cognitive changes and MCI that are related to disease, one of which being Alzheimer’s disease,” Paolillo told Being Patient in a Live Talk. “When things underlying the MCI have potential to be treated, people can see an improvement or at least stability.”

What’s the difference between MCI and Alzheimer’s or dementia?

With aging comes concern about developing Alzheimer’s disease or other forms of dementia, and every lapse in memory or attention can feel like the first sign. However, symptoms of early stage dementia are often similar to many other conditions — including natural aging.

According to Dr. Stephanie Collier, a psychiatrist in the Geriatric Psychiatry Outpatient Services at McLean Hospital, it is important to consider all possibilities.

  • Lapses in memory and trouble with focus can be natural signs of aging, not dementia
  • Because of similarities in symptoms between dementia and other conditions, many psychiatrists hesitate to diagnose dementia in early stages
  • People with dementia have a high chance of developing depression and anxiety, which can make cognitive testing difficult

Being Patient spoke with Dr. Collier about the symptoms of early stage dementia and why diagnosis can be difficult at those stages. Watch that conversation below or read the transcript here.

Dr. Bill Burke, M.D., director of the Stead Family Memory Center at the Banner Alzheimer’s Institute, sat down with Being Patient to discuss what you need to ask your doctor if you think you or a loved one has signs of cognitive decline. Here, he covers:

  • What happens to the brain in normal aging
  • Getting a baseline cognitive test
  • When is M.C.I. a red flag for dementia?
  • Why early assessment matters
  • How to participate in a clinical trial
“Who's going to see me as the same 'me' I've always been, and who is going to, on some level, write me off?” –psychotherapist, marital counselor, and corporate consultant Leah Fisher on coping with her MCI diagnosis

Patient Perspective: Living with uncertainty after an MCI diagnosis

Retired psychotherapist Leah Fisher shares how she learned to live with the uncertainty of mild cognitive impairment, an experience that inspired a song she co-wrote to spread humor and awareness.

Watch, read or listen to our conversation with Leah here.

Patient Perspective: When MCI cut his law career short, he set out on a new journey

Practicing law and working as a trial attorney wasn’t just Dale Rivard’s job — it was his calling. Rivard’s diagnosis of mild cognitive impairment in 2017, however, cut short his career as a prosecutor. The diagnosis was heartbreaking for him and his family at first — but, as he shares with Being Patient, it led to the start of a fulfilling new chapter.

Watch, read or listen to our conversation with Dale here.

Patient Perspective: When MCI cut his law career short, he set out on a new journey

Practicing law and working as a trial attorney wasn’t just Dale Rivard’s job — it was his calling. Rivard’s diagnosis of mild cognitive impairment in 2017, however, cut short his career as a prosecutor. The diagnosis was heartbreaking for him and his family at first — but, as he shares with Being Patient, it led to the start of a fulfilling new chapter.

Watch, read or listen to our conversation with Dale here.

“It doesn’t have the same sort of evidence-based or consistent understanding of how the diagnosis is arrived upon or how it’s used by clinicians,” –Dr. Joshua Grill, Ph.D., associate professor at the University of California Irvine School of Medicine, on diagnosing MCI

How do you tell the difference between MCI, dementia, and normal aging?

How Much Memory Loss Is ‘Normal’?

Oliver Baumann and Cindy Jones, brain health researchers at Bond University in Australia, discuss memory loss and the aging brain.

Does Forgetting a Name or Word Mean I Have Dementia?

Laurie Archbald-Pannone, associate professor of medicine and geriatrics at the University of Virginia, explores the difference between normal memory loss and more severe cognitive health conditions like early Alzheimer’s or dementia.

How Can You Tell the Difference Between Dementia and ‘Normal’ Aging?

Mild cognitive impairment can look a lot like “normal” aging.  As people age, cognitive lapses — like the occasional loss of a word or blanking on someone’s name in a conversation — are “normal” from time to time. How can you tell the difference between this normal aging and something more serious?  Experts about the red flags that can help differentiate typical age-related cognitive changes from early signs of the cognitive decline which may be associated with neurodegenerative diseases like Alzheimer’s.

Is It ‘Normal’ Aging, Or Possible Early Signs of Alzheimer’s?

How can we differentiate between “normal” aging and mild cognitive impairment, the condition associated with early stages of neurodegenerative diseases like Alzheimer’s?

3 Dementia Warning Signs That Appear Years Early

It may be possible to spot a telling combination of three specific dementia warning signs up to 9 years before a dementia diagnosis, according to new research.

How do you treat MCI?

“I have mild cognitive impairment due to Alzheimer’s. Can it be cured?”

MCI can be a symptom of a number of different health conditions. Whether or not MCI is treatable depends on its root cause. In the event that MCI is the result of Alzheimer’s disease or another type of dementia, making lifestyle changes, managing symptoms or exploring disease-modifying Alzheimer’s treatments may help treat MCI symptoms, too.

According to Dr. Sarah Kremen, the director of the Sidell-Kagan Alzheimer’s Disease Treatment Development Program at University of California, Los Angeles, Exactly how long it takes for patients with mild cognitive impairment due to Alzheimer’s to progress to dementia of the Alzheimer’s type, losing their abilities to carry out daily activities independently as their symptoms worsen, depends from one individual to another.

In the meantime, Kremen recommends her patients with mild cognitive impairment due to Alzheimer’s to exercise for 30 minutes a day, which can be broken up into short walks throughout the day. Setting a healthy sleep routine and managing mental health is also crucial. She also advises patients to eat a healthy diet that is low in saturated fat, consisting of fish with fatty acid like salmon, along with food with antioxidants like blueberries and cranberries.

On treating MCI and related symptoms:

Mindfulness as a Brain Protector? A Neuroscientist on Meditation for MCI

We know that exercise could lower your dementia risk by up to 90 percent, but could meditation have a similar impact on the brain? Harvard neuroscientist Sara Lazar shares recent findings on the potential of meditation to reduce stress and fortify the brain against cognitive decline.

COVID Brain Fog? These 6 Things Can Help

Looking for brain fog remedies? Neurological experts offer six ways to speed up recovery from COVID-19’s neurological symptoms.

Can Nicotine Patches Snuff Out Mild Cognitive Impairment? Clinical Trial Underway

Scientists are exploring an affordable way to fight early memory loss by studying the effects of nicotine patches for patients with mild cognitive impairment, which can be a precursor to Alzheimer’s dementia. This approach is not yet backed by science — clinical trials are still underway.