Mild Cognitive Impairment

What You Need to Know About MCI
Senior older woman scratching head

How to help someone with mild cognitive impairment (MCI)

Be sure to get an accurate diagnosis. Mild cognitive impairment (MCI) is sometimes called "pre-dementia," but only about 15 percent of cases each year advance to dementia -- and some cases never do (some people's memories even improve over time). Other causes of these symptoms include medication side effects, head injury, alcohol abuse, and depression.

Action steps

  • Get a thorough medical evaluation of memory-loss symptoms and other changes in thinking skills. Causes such as drug interactions and depression are reversible, so a thorough look at the possible explanations is key. An exam also establishes a baseline against which future cognition can be measured.

  • Share your insights with the doctor. Remember that a key to diagnosis of MCI is a change in the individual. The symptoms of MCI are subtle but unmistakable. Everyone has some trouble with memory now and then, and many people get lost or have poor judgment. What's relevant here is seeing a decided change -- in either occurrence or frequency -- in your loved one.

  • Consider getting a second opinion. You may also want to get the perspective of a specialist, such as a geriatrician, geriatric psychiatrist, neurologist, or neuropsychologist.

  • Ask about medications to retain cognitive ability. Although dementia drugs can't reverse symptoms, as maintainers of ability they've been shown to be most effective early in the disease process. Your loved one may be eligible for medications now.

  • Ask about clinical trials. Nearby universities may enroll patients in studies for new memory-loss treatments. Bonus to participants: All care costs are usually free.

Counter forgetfulness with memory aids. There are two kinds of mild-cognitive impairment: amnestic, referring to memory loss, and nonamnestic, in which other cognitive changes are more prominent. The former is most common. There's occasional loss of immediate memory (those short-term memories that help us function through the day: what we came in the room to get, names and numbers, what was for breakfast, a 3 p.m. appointment), while longer-duration memories of the past stay sharp. Many tools can help your loved one compensate for short-term memory loss, preserving confidence and productivity.

Action steps

  • Rely on such reminders as a centralized calendar and bulletin board, digital clocks in every room, and medication reminders.

  • Encourage your loved one to carry a small notebook and write down "to-do" items, questions, shopping lists, parking locations, and other often-forgotten details that might fail to get stored in short-term memory.

  • Switch as many bills to auto-pay as possible.

  • Explore cognitive training programs, often offered at universities and memory clinics, to boost specific thinking skills. Home software programs are also available.

  • Reduce household clutter, which can be distracting.

  • Buy multiples of commonly mislaid objects (sunglasses, keys, umbrellas) and leave them in their most-used locations.

  • Consider a corded telephone for the home if a cordless unit keeps getting lost.

  • View the use of these tools and other memory tricks as signs of strength, not weakness. Your new motto: whatever works!

Expect language glitches. Increasing trouble finding the right word or remembering what you were just about to say are classic symptoms of mild cognitive impairment.

Action steps

  • Give it time. You don't need to rush in to "cover up" your loved one's communication slow-down -- that can make him or her anxious. If the word or thought doesn't come, change the direction of the conversation.

  • Offer reassurance. Chances are, these changes are upsetting to your loved one. "We'll get through this together" is a powerful, calming message.

More ways to help someone with mild cognitive impairment (MCI)

Expect minor disorientation. Occasionally your loved one may feel confused about where he or she is, or where he or she is going. Or there may be confusion as to the time and date. It's as if the brain has a momentary blip in processing information.

Action steps

  • Be careful not to be critical or show anger. Venting your irritation does nothing for your loved one except make him or her feel worse.

  • Casually help orient the person if you sense hesitancy or sudden quiet, which are common signs of disorientation. Remark on your surroundings, talk about the party you're heading to, or say something like, "Here's that tricky left turn I always hate."

Expect changes in judgment. Another hallmark symptom of MCI: difficulty making choices or decisions. It may show up as a new reluctance to decide or as some inexplicably bad judgments (donating money to an iffy cause, overestimating a skill level).

Action steps

  • Practice patience. Count to ten when you feel your blood pressure rising over another mistake or forgotten engagement.

  • Start to keep a closer eye on finances. Discuss setting up a power of attorney "just in case." Trouble managing money is a sign that MCI is deteriorating into dementia.

  • Don't hesitate to warn your loved one against doing uncharacteristic things that make you nervous (taking up waterskiing, overdrinking).

Encourage steps to improve overall health. Because there's not one single cause of mild cognitive impairment, it's not clear whether symptoms will respond to lifestyle changes that might prevent or slow the impairment from progressing into dementia. But since certain factors are linked to better cognitive health, it can't hurt to practice them now.

Action steps

  • Encourage your loved one to consider an MCI diagnosis as a wake-up call to establish a living will and other advance health care directives.

  • Serve a heart-healthy, brain-healthy diet. Heart disease and diabetes are risk factors for mild cognitive impairment.

  • Stay in the social whirl. Keep your loved one active in work, clubs, socializing, and other people-oriented activities as long as possible to avoid potentially damaging social isolation. Beware that memory changes can cause some people to become fearful and prefer to retreat, which isn't healthy.

  • Encourage intellectual pursuits. Promote habits like reading the newspaper, playing games or working puzzles, and learning new things for as long as is pleasurable and possible.

How to help yourself

Learn all you can about memory impairment issues. Knowledge really is power. Cognitive changes occur along a spectrum. Mild cognitive impairment is far closer to normal aging than to full-blown Alzheimer's disease or other forms of dementia. But understanding this spectrum helps you know what kinds of changes to watch for and what behaviors are caused by cognitive impairment (not by the person you're caring for).

Action steps

  • Learn the symptoms of mild cognitive impairment and what to do about them.

  • Preview information about mild dementia. You'll be more likely to keep your cool, better able to plan ahead. The major difference from MCI: Dementia interferes with everyday functioning.

  • Consider a memory-impairment support group for your loved one and/or yourself. This growing type of support helps memory-loss sufferers compensate and cope. Ask your doctor or a local hospital for referrals.

Figure out your sources of strength -- and stoke them. Mild cognitive impairment can be frightening, annoying, and occasionally almost comical to live with. ("Why did you send me three birthday cards?") But the slipups and confusion can take a toll. You need to preserve your own well-being so you can be your loved one's best advocate in the months and years ahead.

Action steps

  • Carve out "just for me" time every day. Whether it's 15 minutes or an hour, it's sanity-saving, not selfish, to establish a habit of making yourself a priority, even in these scary times.

  • Find ways to vent anger. Better to let it out in a gym or by screaming in your car than in front of your loved one -- or than letting it bottle up.

  • Stay social yourself. In a crisis, it's common to draw inward. But being among others is good for you.

  • Consider talk therapy. Even though you don't have to do very much to be a caregiver to your loved one yet, the added stress and worry about memory changes can put you at risk for depression. A counselor or therapist can help you offload your stress constructively.

Stoke up your own health habits. It's impossible to know what's causing your loved one's mild cognitive impairment, but chances are good that you share many lifestyle habits, some of which may have upped the risk for this condition. Consider MCI a wake-up call to preserve your best health habits while making smart changes.

Action steps

  • Keep your exercise time sacrosanct. Doctors now agree that regular exercise is probably the number-one way to ward off disease and slow age-related changes. It's also an incredible stress reliever. Figure out what you like to do, when you can do it -- and plan the rest of your schedule around these sacred times. Even if this means waking up early a few days a week, the benefits are worth it.

  • Optimize the whole household's diet. Making food changes is easiest when everybody's doing it.

  • Make medical appointments -- for yourself. In the understandable focus on your loved one, it's easy to ignore your own basics. Make a year's worth of your own appointments, including an annual physical, follow-ups with any specialists, and checks for hearing, vision, and skin. Arrange to get a seasonal flu shot, too.

How to build your support system

Decide how you'll share information, and with whom. Together with your loved one, decide who else should know about your loved one's mild cognitive impairment.

Action steps

  • Ultimately, respect your loved one's wishes. Despite the symptoms, he or she is still of considerably sound mind. There may be practical reasons to withhold information about symptoms and treatment from an employer, for example, or from others. At this point, take it slowly.

  • Decide together how you'll respond to questions from others. Family members and close friends often see the changes associated with mild cognitive impairment before there's a diagnosis. Many may ascribe these to "old age," while others may urge medical care. Talk through with your loved one how you'll respond.

  • Be aware that more people have dealt with memory-loss issues than you may realize.

  • Choose at least one confidante. You and your loved one may decide not to share the news about memory issues widely yet, but having at least one other person who knows what's up has practical and personal benefits. You may need a backup for emergencies. And a discreet sounding board never hurt.

Never be shy about asking for help as needed. It's a reflex that will serve you well now and in any future health crisis.

Action steps

  • Vow not to expect friends and family to be mind readers. Nobody is going to know what kind of help you need unless you ask. Be specific. You may not need anything special just yet, but if you do -- even if it's just borrowing flour because your loved one forgot it, again, at the grocery store -- most people are far more happy to be asked than you might expect.

  • Remember the power of group-think. You may be inclined to circle the wagons and keep mum about MCI. But others can be good sources of information about doctors, clinics, support groups, and other resources.

6 months ago, said...

Caregiver respite is almost impossible for me. Any suggestions?

over 5 years ago, said...

Right from the get-go, this article focuses on memory loss issues. Please be aware that Mild Cognitive Impairment does not ALWAYS start with, or even involve, memory impairment. At my house, the changes which led to diagnosis of MCI were all behavioral changes, not memory changes: impaired "executive" functioning, involving loss of good judgement, of adequate problem-solving and decision-making capability, of appropriate impulse control and inhibition, of sequencing skills, and of mental breadth and flexibility. Caregivers of those with such MCI do not receive help or support when the primary focus is limited to memory impairment.

over 5 years ago, said...

I especially liked the "whatever works" motto. So true! I consult for a home care company that offers a free guide for caring for someone with dementia if your readers would like to check it out. Best of luck to all who are facing this challenge!