Mild Cognitive Impairment

Photo ©iStockphoto.com/ Yakobchuk

Bob and Anne McAndrew are engaged in a spirited back-and-forth discussion as they describe how their lives have changed since Anne was identified a few years ago as someone who could benefit from a program at Baycrest that helps people with mild cognitive impairment, or MCI. Like many a husband and wife who have been together for a long time, the Toronto couple is so in tune with each other that one of them can start a story and the other will affectionately pick it up part way through and bring it effortlessly to the finish line.

Bob recalls that before Anne was flagged with this condition that affects her memory, he had “a terrible habit” of correcting her when she was talking to people and getting the facts mixed up.

“When we’d be in a social group, Anne would be telling a story from her point of view, and whenever I thought that she was making an error, I would verbally correct the factual area, and it got to a point with her friends that it was sort of a social joke, that Bob was always interrupting,” says Bob, 78, a retired University of Toronto engineering professor.

At this point, Anne playfully interjects: “I just have to say, that unlike Bob, I never let the truth interfere with a good story.”

Bob says that once they learned more about the nature of her mild memory deterioration, he tried hard to minimize the interruptions.

Good-natured bantering aside, it was alarming to Anne when she would sometimes turn on the hose in the garden, for instance, and realize the next day that she had left it running overnight, or that she’d left a pot to go dry on the stove.

Anne, a graduate of Queen’s University and a retired nursing teacher at Seneca College, started noticing these rare occurrences in her mid- to late 70s. Now 85, she doesn’t try to hide the fact that she has some issues with remembering.

“I talk about it freely and we have quite a number of friends who suffer from the same degenerating process, who have made efforts to find more information, become familiar with the degeneration and take steps to alter it. I became kind of a – what would you call it?”

“A missionary,” Bob says helpfully, before Anne continues: “When we go south, we own an apartment there, and we’ve known the people for a long time, and a lot of them are people of our age, so when I see some symptoms or signs that I’ve undergone, then I very diplomatically start to guide them.”

MCI – A boundry zone
Dr. Nicole Anderson, a clinical neuropsychologist at Baycrest, says mild cognitive impairment is the boundary zone or transition state between normal aging and dementia. Along with her Baycrest colleagues, Dr. Kelly Murphy and Dr. Angela Troyer, she has written Living with Mild Cognitive Impairment: A Guide to Maximizing Brain Health and Reducing Risk of Dementia. The book is available for purchase at Oxford University Press and amazon.ca. This is the first book of its kind on MCI for the lay population. It contains detailed information about the condition, and is packed with advice for individuals and their families on how to maximize brain health and reduce the risk of a progression to dementia.

About 10 to 15 per cent of adults aged 65 and older are believed to have mild cognitive impairment, which causes cognitive problems that go beyond what would be expected due to normal aging, Dr. Anderson explains in an interview. “But they’re not as severe as we see with dementia. And the other critical difference between MCI and dementia is that people with MCI are able to function independently.”

It is important to identify these people because they are at a high risk of developing dementia, she says. She cites studies that have followed people with MCI – especially those with memory impairment as one of their cognitive problems – and have found that over six years, 80 per cent of them have gone on to develop Alzheimer’s disease. By comparison, she says, in a large group of healthy older adults without MCI, between eight and 16 per cent would develop Alzheimer’s disease over six years.

“Being diagnosed with MCI is really a call to action, because it gives you a window when we can intervene and at least try to slow that process down, if not prevent it.”

Term coined in 1999
The term mild cognitive impairment began to receive widespread attention in the research community after the Archives of Neurology published a paper in 1999 by Dr. Ronald Petersen and other investigators at the Mayo Clinic, laying out some diagnostic criteria. Since then, there have been thousands of papers on the subject, but Dr. Anderson notes that “it’s surprising the uptake in the general population just hasn’t happened.”

The most typical effect of MCI is memory problems. Also common are subtle language difficulties and the inability to switch back and forth between two tasks or ignore irrelevant information to stay focused on a task. Dr. Anderson says that for the most part, a casual observer cannot discern that someone has MCI. In the workplace, increased reliance on a calendar, daytimer or administrative assistant will help someone stay on track. Intellectual capacity to get the job done is not affected. In fact, Dr. Anderson knows of company CEOs who have the condition, and they are still doing well.

“It’s that subtle, that only if you’re spending a lot of time with them will you start to notice a repeated question or statement or something. This is pretty subtle, the changes that are happening, and so there’s no reason why people with MCI can’t do all the things that everybody else enjoys.”

Possible outcomes
There are three possible outcomes for people with mild cognitive impairment: They will progress to dementia, remain stable or revert back to normal aging. MCI describes the presence of cognitive dysfunction on the day of assessment. The dysfunction on that particular day might be due to reasons that potentially could be addressed – thyroid levels are off, there’s a vitamin B12 deficiency, the person is stressed or perhaps didn’t sleep well the night before.

When tested again, usually at least 18 months later, the individual might be normal. “People can bomb one test for a variety of reasons, but if they’re having trouble with multiple tests in a domain, then that’s more reliably indicating that they have a real problem,” Dr. Anderson says.

Causes of MCI
The foremost potential cause of MCI is Alzheimer’s disease, but a series of small strokes could also be to blame or a head trauma. Age is a non-modifiable risk factor. Dr. Anderson says the average time of onset is in the 70s, but it can occur earlier.

To date, no drug treatments have been approved, and Dr. Anderson notes that the recommendations included in the book are not going to change the underlying pathology. “What they’re going to do is build up compensation, a reserve so that the effects of that brain pathology are minimized, and that will help to delay progression to dementia.”

More on MCI

Courtesy of Baycrest, the global leader in innovations, research and breakthroughs for the journey of aging.