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Does Mild Cognitive Impairment (MCI) Always Progress to Dementia?

Jeff went into the garage—and forgot why he was there. Only when he sat back down at his desk did he recall he’d intended to retrieve his reading glasses out of the car. “Is something wrong with my memory?” he wondered. “This isn’t the first time I’ve had lapses like this.”

It’s natural to worry about changes in our memory as we grow older. It seems we aren’t as able to remember names. We might forget where we parked at the mall. We’re a little slower to add numbers in our head. And we might experience “tip of the tongue” errors where we struggle to remember a word, only to have it come into our head later.

Most likely, say gerontologists, these changes are within the range of expected, normal changes in the aging brain. But if you are worried, or if friends and family express concern about your memory problems, it’s time to report the problem. Your doctor might use memory tests, observation and perhaps brain imaging to find out what’s going on.

Often, the diagnosis is mild cognitive impairment (MCI), a condition that is typified by problems in thinking and memory, but is not considered dementia. People with MCI might misplace items, get lost, and have trouble paying attention or completing tasks that are usually simple for them.

It might be tempting to ignore worrisome memory problems, especially when incidents seem to come and go. But don’t put off talking to the doctor. Many of the causes of MCI are treatable. How sad to worry and to deal with worsening symptoms, when the problem could be due to an infection, vitamin deficiency, sleep problems, depression, sensory loss or the side effects of medications.

And while many people whose MCI is newly diagnosed believe that their condition is the inevitable first step toward Alzheimer’s disease, studies show that is not necessarily the case. MCI symptoms may remain stable for many years. In fact, a December 2021 study published by the American Academy of Neurology found that a diagnosis of MCI might be temporary.

A research team headed by Jennifer J. Manly, Ph.D., of Columbia University examined six years of data from almost 3,000 older adults. During that time, 480 of the seniors received a diagnosis of MCI.

Yet when those 480 study participants went back for a follow-up examination two years later, the diagnosis was reversed for many. While 13% had progressed to dementia and 30% still met the criteria of having MCI, 48% no longer met the criteria for a diagnosis of MCI and were instead classified as cognitively normal.

Manly and her team pinpointed certain factors that were common among study participants who experienced memory decline, including depression, a family history of dementia, low education, inactivity, social isolation and several underlying health conditions.

“These results will help us to better understand who is at high risk for dementia so we can identify people for prevention strategies or intervention methods,” said Manly. “Especially where risk factors can be modified, these results could be important for public health initiatives. The results highlight that MCI is a classification associated with increased risk for progression, but not everyone goes on to develop dementia.”

A second study, published by the Society for Neuroscience in January 2022, notes that certain older adults can be classified as “cognitively frail,” experiencing thinking and memory problems even though imaging shows their brains appear normal. “At the first sign of cognitive trouble, people often worry Alzheimer’s disease is forthcoming,” said the team, headed by Dr. Ece Kocagoncu of the University of Cambridge in the U.K. “But poor cognition can be part of the spectrum of normality in older age.”

The researchers all emphasize that MCI, “cognitive frailty,” and normal age-related changes in thinking and memory can be improved by modifying certain risk factors and making beneficial lifestyle changes. Neurologists recommend these steps:

  • Increase physical activity.
  • Eat plenty of “brain-healthy” foods.
  • Get plenty of mental exercise.
  • Spend more time with others.
  • Manage underlying health conditions.
  • Have medications reviewed.
  • Treat depression and anxiety.
  • Address sleep problems.
  • Don’t smoke, and limit alcohol.

Making these changes might even slow the progression of Alzheimer’s disease and other types of dementia, and experts say this is very important for patients and families to know. A November 2021 study from Rutgers University found that in reaction to a diagnosis of dementia, patients often begin to withdraw from social interactions and become less active and engaged in the community—exactly the opposite of what would benefit them. No matter what the diagnosis, people with memory problems should be encouraged to continue doing things they enjoy, modifying activities as their needs change. Counseling and support groups can help.

Right at Home’s trained professional caregivers help support the physical and cognitive health of senior clients, including memory care for people living with dementia. Contact your local Right at Home* today and ask for a FREE in-home consultation.

*In-home care services vary by location.

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Right at Home offers in-home care to seniors and adults with disabilities who want to live independently. Most Right at Home offices are independently owned and operated, and directly employ and supervise all caregiving staff.
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