Mild Cognitive Impairment: What It Is and What Families Can Do

Normal ageing, MCI and dementia

Normal ageing: occasional forgetfulness, such as misplacing keys or forgetting a name that returns later; slower recall; needing more time to learn. The person is aware, and daily life is not affected.

MCI: memory or thinking changes noticed by the person or others, confirmed on testing as below expected, but without significant loss of independence. The person may need more reminders, make more mistakes with finances or take longer with complex tasks, but still manages.

Dementia: memory and thinking problems severe enough to interfere with daily life: managing medicines, money, cooking, getting dressed, getting lost, personality changes. See dementia stages and what each needs.

The line between MCI and early dementia is a matter of degree and day-to-day function, which a doctor assesses.

Types of MCI

• Amnestic MCI: mainly memory loss, more linked with later Alzheimer's disease.
• Non-amnestic MCI: problems with language, attention, planning or visual-spatial skills; may link to other dementias, such as Lewy body or frontotemporal dementia, or vascular causes.

Possible causes

Many conditions can cause or worsen memory and thinking problems. Some are treatable, so assessment matters.

• Early Alzheimer's disease or other neurodegenerative disease.
• Vascular causes: high blood pressure, small strokes, diabetes, high cholesterol, atrial fibrillation; see hypertension home care guide and preventing a second stroke.
• Depression, anxiety and stress, which commonly mimic or worsen memory loss; see depression in older adults and anxiety in older adults.
• Hearing loss and poor vision, which reduce input and increase strain on the brain; see hearing loss: a home and family guide and hearing aids and dementia risk.
• Sleep problems, including sleep apnoea; see sleep problems in older adults and sleep apnoea in older adults.
• Medicines: some sleeping tablets, bladder medicines, antihistamines, anxiety and pain medicines and others can impair thinking; see polypharmacy and deprescribing and medicine side effects families should watch. Never stop prescribed medicines yourself; ask the doctor.
• Vitamin B12 deficiency, thyroid disease, anaemia, kidney or liver problems, low sodium or calcium; see vitamin B12 in older vegetarians and thyroid problems in older adults.
• Alcohol and substance use; see substance and alcohol use in older adults.
• Infections, delirium after illness or surgery; see delirium in older adults.
• Head injury, normal pressure hydrocephalus, tumours, chronic subdural bleeds.
• Grief, isolation and inactivity; see loneliness and isolation in older adults.

What to do first: see a doctor

If memory or thinking changes are persistent, are worrying the person or family, or interfere with life, see a doctor, ideally with someone who knows the person well. Call the doctor urgently if the change is sudden or rapid over days or weeks, accompanied by confusion, drowsiness, fever, severe headache, weakness or speech change (call 112 for stroke signs; see stroke warning signs and the first hour).

What the assessment may include - History: from the person and a family member, covering onset, progress, examples, daily function, mood, sleep, medicines, alcohol, head injury and family history. - Examination: blood pressure, heart, nervous system, hearing and vision. - Cognitive tests: short paper tests of memory, attention, language and planning, sometimes repeated over time. Results vary with education, language, mood and anxiety, so interpretation needs care. - Blood tests: blood count, thyroid, B12, glucose, kidney and liver function, calcium and others as indicated. - Brain imaging: a CT or MRI scan, if needed. - Referral to a memory clinic, geriatrician or neurologist, for further tests. - Review of medicines and treatable factors.

Bring a list of medicines, notes of examples of problems and a family member. See preparing for a doctor's visit with a parent.

What the diagnosis means

An MCI diagnosis does not mean dementia will follow. Studies suggest that a proportion of people with MCI develop dementia over several years, others remain stable, and some return to normal, especially if depression, medicines, sleep or other reversible causes were contributing. Regular review, typically every six to twelve months, tracks change. No medicine is proven to prevent MCI turning into dementia, and doctors generally do not recommend dementia drugs for MCI. Be wary of products sold for memory, such as herbal tonics and supplements, and ask the doctor before using any; see supplements and medicine interactions.

Healthy habits that support the brain

The strongest evidence concerns reducing risk factors for vascular disease and dementia and keeping the brain and body active:

• Control blood pressure, blood sugar and cholesterol, taking prescribed medicines as directed; see how to measure blood pressure at home.
• Be physically active: regular exercise, walking, strength and balance; see walking programme for older adults and exercise at home for seniors: a safe starter guide.
• Eat a healthy diet, rich in vegetables, fruit, pulses, whole grains and nuts, with less salt, sugar and fried foods; see nutrition for heart health after 60.
• Treat hearing and vision loss: wear hearing aids and glasses; see hearing aid buying guide and hearing and vision checkup schedule.
• Stay socially connected: family, friends, groups, faith communities.
• Keep the mind active: reading, puzzles, learning, music, games, hobbies, volunteering.
• Sleep well, and treat sleep apnoea.
• Avoid tobacco and limit alcohol.
• Look after mood: treat depression and anxiety.
• Protect against head injury: prevent falls; see falls risk assessment at home.
• Maintain a healthy weight and manage diabetes; see diabetes at home after 60.
• Reduce air pollution exposure where possible; see pollution season plan for seniors.

None of these is a promise, but together they improve overall health and may reduce risk.

Supporting daily life at home

• Routines: regular times for meals, medicines, exercise and sleep; see dementia daily routines for helpful routines.
• Memory aids: a wall calendar, a diary, a whiteboard, labelled shelves, a place for keys, glasses and phone, phone reminders and alarms; see orientation aids for memory loss, talking clock guide and phone accessibility features for seniors.
• Medicines: a pill organiser, alarms, and a check-in; see pill organiser guide and medicine reminders for forgetful parents.
• Appointments and finances: a shared calendar, a family helper, safeguards against scams; see managing a parent's money safely and preventing doorstep scams and phone fraud.
• Cooking safety: timers, auto-off appliances; see auto-off kettle and stove safety.
• Driving: ask the doctor about safety; stop if there are near-misses, getting lost or others' concerns.
• Respect independence: let the person do what they can, and assist unobtrusively. Avoid correcting every mistake.

Communication and emotional support

Receiving a diagnosis of MCI can cause worry, fear and stigma. Be honest and hopeful. Listen. Encourage the person to share feelings and to take part in decisions. Avoid treating them as incapable. Consider counselling and support groups. If low mood or anxiety is present, seek help. See dementia communication tips for patient communication principles, and dignity and consent in care.

Planning ahead, without panic

While the person is able to take part, discuss and document their wishes: legal matters such as power of attorney and a will, finances, preferences about care and living arrangements; see legal basics: wills and power of attorney and advance care planning in India. Learn about dementia, so you know what to expect, and who to ask for help. Keep a health record; see keeping a health record at home.

Monitoring over time

Keep a simple diary of changes: new difficulties, getting lost, medication mistakes, money problems, personality changes and how long they last. Attend follow-up appointments. Seek earlier review if there is a clear step down, a fall, illness or a change in mood or behaviour. Repeat testing is commonly used to see change.

When to ask a professional

Ask a doctor for any persistent memory or thinking change, and a memory clinic, geriatrician or neurologist for further assessment. An audiologist and eye doctor can check hearing and vision. A psychologist or counsellor can help with mood and coping. An occupational therapist can advise on strategies. For senior services, call Elderline 14567. In an emergency, call 112.