When we hear the phrase, “cognitive impairment,” our first reaction is often fear. “Uh-oh,” we may think – “when I forgot that appointment last week, or misplaced the car keys, was that the beginnings of cognitive impairment? Does that mean I’m losing it mentally?”

When it comes to what doctors call mild cognitive impairment, or MCI, there’s some good news and some bad news. The good news is that a few forgetful episodes here and there don’t mean you have MCI – and even if you do, that doesn’t necessarily mean you’ll develop Alzheimer’s disease or some other form of dementia. But the bad news is that too many people ignore the warning signs of MCI for far too long, and that means they fail to get the help that might arrest or improve the symptoms before they get worse.

This past week we discovered this timely article about mild cognitive impairment on the website of the Washington Post. Written by reporter Katherine Ellison, the piece warns that the vast majority of MCI cases go undiagnosed. But if caught early, worsening symptoms can be slowed or stopped altogether – or even reversed. (You’ll find more information on reversing dementia symptoms in this recent article here on the Blog.)

The point: if you suspect that you might be developing mild cognitive impairment, let go of the denial and seek an accurate diagnosis. You owe it to yourself and to those you love.

Ignoring Signs of Cognitive Impairment for Six Years

Ellison begins with the story of Jonel Dershem, a New Jersey obstetrician who first noticed problems with her memory at age 50, just after breast cancer surgery. Ellison writes that Dershem “at first blamed the lapses on chemotherapy, and then on her busy, stressful life. So did her husband and friends — and doctor.”

It started with little things, like leaving the faucet running, and it progressed to difficulties finishing routine tasks. “I kept blowing it off,” Dershem says. “I was our family’s primary breadwinner. I didn’t want there to be any serious problems.”

Dershem was finally diagnosed with mild cognitive impairment (MCI) nearly six years after her memory loss began. Ellison writes, “Her delayed diagnosis wasn’t unusual, but experts say that needs to change.”

Mild Cognitive Impairment Can Be a Precursor to Dementia

Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center and Study of Aging, defines MCI as impairment that goes beyond occasional forgetfulness; instead, it “causes problems that disrupt daily life but don’t make it impossible to function.”

Petersen is intimately familiar with MCI’s finer points, as he led the first 1999 study finding the differences between MCI patients, healthy subjects, and individuals with dementia. He calls MCI a “subtle condition”, and adds that if you miss an appointment or forget a task once, that’s not necessarily something to be concerned about. But if “that happened a couple of times last week and people in your family are starting to worry about you — well, that may be MCI.”

Petersen adds, “With MCI, people can still drive, pay their bills and do their taxes — they just do so less efficiently.”

Mild Cognitive Impairment Affects 10-25 Percent of Seniors

Ellison writes, “A 2022 study in the journal Alzheimer’s & Dementia projected that14.4 million people in the United States would have MCI in 2025, and 19.3 million in 2050. An American Academy of Neurology subcommittee estimated that about 1 in 10 people ages 70 to 74 had MCI, and 1 in 4 ages 80 to 84 in 2018.”

And even though it’s tempting to push potentially worsening symptoms under the rug, experts agree that waiting to get diagnosed is dangerous. Dershem, for example, had to raise her concerns about her worsening condition three times with her own doctor and two neurology specialists before she finally received her MCI diagnosis.

This is why, according to expert Soeren Mattke, both doctors and patients need to be aware of the symptoms of cognitive decline. Mattke, who is the director of the Brain Health Observatory at the University of Southern California, adds, “If you wait until someone’s obviously symptomatic — like they can’t find the door to the physician’s office — you’re going to be too late.”

Don’t Ignore Warning Signs of Mild Cognitive Impairment

The numbers show that a huge majority of MCI sufferers are undiagnosed, as many as 92 percent according to research published last year. Ellison writes, “After analyzing data from 40 million Medicare recipients aged 65 and older, the authors of the study in the journal Alzheimer’s Research & Therapy found that only about 600,000 of the expected 8 million affected by MCI had been identified.” These rates are even lower for historically disadvantaged groups, such as Black and Hispanic Americans.

Time is of the essence in diagnosis, according to David Weisman, who currently serves as director of clinical research at Abington Neurological Associates, and is also Dershem’s current doctor. Significant declines in memory, difficulties taking in new information, increased clumsiness, and problems understanding social cues (like becoming easily offended in ways you weren’t before) are all signs that it’s time to talk to a doctor. 

“The advantage of catching MCI early is that we can delay progression. Later on, less,” Weisman says. “In neurology we learn the same lessons again and again: Time is brain.”

Treating MCI: New Drugs Show Promising Results

A recently-approved drug called lecanemab (brand name Leqembi) is used by Weisman and others to treat MCI and early Alzheimer’s disease based on clinical trials that show it modestly slows dementia’s progress (though, Ellison notes, it can’t stop the decline or make up for lost ground). Lecanemab and donanemab (the latter of which has yet to be federally approved), are both medications which reduce “the buildup of amyloid beta, a protein in the brain that is a hallmark of Alzheimer’s,” Ellison writes.

The drugs only work, however, if the disease is caught as early as possible. And they can come with significant side effects, including brain swelling and bleeding.

Another reason why early diagnosis is vital, according to Petersen, is because there’s also the possibility that the cognitive decline could be caused by something else, like a brain tumor, or the side effects of another medication, or even sleep apnea. You definitely want a thorough diagnosis.

Fight Mild Cognitive Impairment by Making Memory a Priority

Ellison reminds us that it’s not abnormal to experience some deterioration in memory and ability to process information as we get older, though she notes that “the pace and degree vary from person to person.”

She writes, “Brain volume shrinks on average by about 5 percent per decade after age 40, with the rate possibly accelerating after age 70. (Microbleeds in the brain due to declining vascular health may also affect brain function.) If you find yourself having a little more trouble keeping up with conversations, losing the keys or temporarily forgetting the name of that guy you worked with for six years in the 1980s, that’s just part of the journey.”

But she also urges: if it feels like more than just the normal lapses that come with aging, talk to your doctor early – and emphasize your desire to get answers.

“If you go in and say, ‘I have the following 20 problems, and memory loss is number seven,’ it’s just not going to work,” Weisman said. “If you feel your doctor isn’t taking your worries seriously, consider consulting a geriatric psychiatrist or neurologist.”

Evaluating Mild Cognitive Impairment: What to Expect

One way to streamline the process is to take an online test and bring your doctor the results. According to Ellison, the “gold standard” is the downloadable Self-Administered Gerocognitive Exam (SAGE). However, she warns, beware of others that may be covers for ads.

Ellison explains, “Your doctor may conduct a more thorough test or a battery of neuropsychological assays before moving on to blood tests or an MRI to look for possible physical problems. If other causes are ruled out, a PET scan or spinal tap may be used to search for signs of Alzheimer’s disease or Lewy body dementia, the second-most-common cause of dementia. New blood tests promise to make diagnosis easier in time.”

Others Will Notice Your MCI Before You Do

Mattke notes that those who experience serious cognitive decline likely won’t be the first to notice. This is why it’s paramount, according to Weisman, that you bring a “personal historian” with you to your appointment: “A spouse or friend who may have a better idea than you do about the onset and pace of your decline.”

In Dershem’s case it was her college-age son, Bryce, who filled that role for her when he noticed her increasing forgetfulness in the middle of making meals or typing up her notes from work, something she had always done without issues before. 

“If possible,” Ellison writes, “bring someone with you to all medical appointments.”

What if Tests Confirm Mild Cognitive Impairment?

And if you do get diagnosed with MCI, what then?

Petersen says, no matter how old you are, it’s very important to take care of your brain. This includes managing any other illnesses you might have and living the healthiest lifestyle you can, with regular exercise, sufficient sleep, limited alcohol and stress, and an “engaging” social life.

“Diet is also important,” Ellison writes. “Researchers have found that trading saturated and trans fats (in foods like beef ribs, sausage, butter, and commercially baked cookies and cakes) for unsaturated fats (think seafood, walnuts and olive oil) is associated with slower cognitive decline and decreased risk of onset of Alzheimer’s disease.”

There are other tools and resources available, too. Ellison adds, “A 2019 pilot study found that a six-week classroom program of memory training may help slow decline. It’s also a good idea to fortify your memory-support tools, such as calendars and notes and daily routines, and to put your keys, phone and glasses in the same place each day.”

Rajiv Agrees that MCI Triggers “Hard Thinking About the Future”

Eventually, a diagnosis of MCI that’s on track to dementia should inspire some hard thinking about the future, including considering alternative arrangements for driving, designating a surrogate decision-maker for health care and financial affairs, and executing a will.

But there’s so much more to the story of cognitive impairment, mild or otherwise. Just last week Rajiv offered his take on an article concerning a sudden diagnosis of dementia. The view he offered then bears repeating. First off, the diagnosis of cognitive impairment doesn’t have to leave you feeling helpless.

“There are still plenty of things you can do to stabilize and even reverse the progress of [cognitive impairment], besides just waiting for it to get worse,” he states emphatically. “Plenty of recent studies [including this one from the Cleveland Clinic] have shown that basic things like diet, exercise, and proper sleep can improve symptoms.  A famous study of aging nuns showed how a life of purpose can keep dementia symptoms at bay even when all the physical signs are there. Bottom line is, there’s definitely hope that you can actually reverse dementia.”

What about the housing issue, we asked Rajiv? Does a diagnosis of cognitive impairment or dementia mean you’ll have to move? “No, not necessarily,” Rajiv responds. “You may be afraid you’ll have to move to a nursing home or that you’ll become an unbearable burden to your loved ones. Neither needs to happen!”  Instead, he urges, you and those closest to you should focus on building a plan that will guarantee that the care you require will come to you, even as your needs increase. “Your loved ones don’t have to become your unpaid caregivers,” says Rajiv, “and you don’t have to run out of money, if you plan properly.” 

The Outlook for Those with MCI May be Improving

While Ellison understands that all of this may sound “gloomy”, the good news is that research shows an overall decline in dementia rates worldwide, “driven mainly by improvements in cardiovascular health. Researchers and policymakers are paying more attention to the problem, reducing the stigma and producing new treatments.”

Petersen adds, “My guess is that within five to 10 years from now, we will have better biomarkers for what’s causing MCI and dementia — and combination therapies to treat them in each patient.”

And Dershem? She has already gotten good news. Ellison writes, “During her first 11 months of treatment for MCI, she saw no further evidence of mental decline.” Both Dershem and her doctor think that the twice-monthly infusions might not be the only reason for this. The reduced stress of being retired, along with consistent exercise, watching her diet, and spending more time with her children have all played a role.

Dershem says, “I’m just trying to do everything I can.”

(originally reported at www.washingtonpost.com)