Mild Cognitive Impairment

Definition

Isolated cognitive impairment(s) identified as abnormal (compared to expected) and representing a decline from previous level of function.  The cognitive impairment should not be so severe as to affect social or occupational functioning (at which point the diagnosis of dementia would be more appropriate).

Background

  • It is uncertain whether MCI is a normal sequelae of the aging process or whether there is a pathological process underlying it
    • Risk/contributing factors include
      • Cerebrovascular events
      • Hypothyroidism and parathyroid disease
      • Malnutrition and vitamin deficiencies (e.g. B12 and folate)
      • Polypharmacy (especially sedating medications)
      • Mood disorders
      • Drug/alcohol abuse
  • It is a significant risk factor for dementia (around 15% of patients with MCI progress to dementia per year (usually Alzheimer’s); and up to 50% later develop dementia)
  • There are several different ‘types’ of MCI
    • Amnesic (poor memory function)- most likely to go on to develop Alzheimer’s type dementia
    • Non-amnesic MCI
      • Usually impairment of executive function e.g. ability to make sound decisions, judge time or sequences involved in complex tasks, visual perception etc

Presentation

  • Most present with vague symptoms of cognitive decline (e.g. poor memory- forgetting conversations, recent events etc)
    • Quite often, relatives or close friends are more concerned
  • Note that it can be difficult to tease apart what is MCI, what is normal and what could be secondary to other problems e.g. sensory impairments

Assessment

  • There are several assessments commonly used to identify cognitive impairment
    • The Mini-mental state examination (MMSE) is the most commonly used in practice to quickly assess cognition
      • Addenbrooke’s testing is more extensive and is usually used for formal assessments
    • Other tests include the 6-CIT, AMT, GPCOG and the 7 minute screen.
  • Other routine tests (e.g. FBC, U&Es, Calcium, Glucose, LFTs, B12/folate, TFTs) should be performed to rule out an potentially reversible cause

Management

  • Coping mechanisms e.g. lists; tackling one job at a time; memory aids (clocks/watches/calendars; storage places for items such as keys/glasses; setting reminders etc)
  • Patients with MCI should be followed up every so often to check that there has not been a deterioration
    • Referral to a specialist should be made if cognitive decline is thought to be impacting on daily living (i.e. dementia is being considered)

 

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