Living With Mild Cognitive Impairment

How to maximize brain health and reduce the risk of dementia

Would Woody Allen Worry?

What to do if you suspect you might have mild cognitive impairment (MCI).

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First, I am not saying Woody Allen has MCI. One of the things he is famous for, however, is playing characters who worry. It’s easy to imagine him playing the role of an older gentleman worried about his memory. {For a brief description of MCI go to http://www.psychologytoday.com/blog/living-mild-cognitive-impairment/201304/mci-is-being-stuck-in-the-middle } 

ACT 1, Scene 1: At the doctor’s office. The older gentleman says to his doctor:

“My wife says I keep getting our schedule mixed up, thinking something’s happening this Thursday when really it’s next Thursday. I never used to do this. Could this be a sign that I am experiencing memory decline? Could I have MCI? Could this lead to dementia? My aunt, on my mother’s side, had dementia? Maybe I’ll get it? How can I find out? What should I do?”

Following up on concerns

Ok, so going to a family doctor to express your memory concerns is a good first step. Why? Because the family doctor can help you work through and rule out potential causes, some of which are reversible. For example, are you depressed? Are you currently experiencing a stressful life situation? Do you have a vitamin deficiency? Could there be a problem with how your thyroid gland is working? The latter two can be figured out with routine blood tests. All of the above mentioned potential causes, when properly managed, can result in your memory improving back to your normal. You should also be prepared to tell your doctor about how your problems started. Where they sudden or gradual in onset? Do they seem to be worsening? Have others noticed the problem? If you go to http://www.baycrest.org/publications-27-mci.php you can download a questionnaire to fill in that will help you prepare for a visit with your doctor to discuss your concerns.

What your doctor might do

  • Question you about your memory concerns, your mood and any recent life changes
  • Help you better manage and / or prevent modifiable risk factors for dementia, such as diabetes, high blood pressure, and high cholesterol
  • Order blood tests to check for imbalance in hormones or vitamin levels
  • Perhaps conduct a cognitive screening test
  • Question you about how you are managing with your daily responsibilities, such as getting around town, doing your banking, and keeping track of your commitments
  • Possibly order a brain scan to see if there is evidence of a stroke, tumor, or greater than age-expected shrinkage of the brain
  • MONITOR over time to see if things seem to be getting better or worse
  • Perhaps refer you to a specialist. For example, a neurologist who focuses on disorders of the nervous system, or a neuropsychologist who focuses on cognition and brain health. 

At present there is no definitive medical test for MCI. In-depth cognitive testing of your thinking skills can be most helpful in confirming diagnosis of MCI. If MCI is suspected then there are three possible outcomes your doctor will want to continue to follow you for.

Possible outcomes of MCI

  • Improves back to your normal
  • Remains stable
  • Progresses over time to dementia

Now these outcomes are influenced by risk factors, some of which we have control over and some of which we don’t. Risk just means that more people with dementia have these factors that do people who don’t have dementia. Risk means “maybe” it doesn’t mean it’s a sure thing.  Age is the biggest risk factor for dementia. Nothing you can do about that. There are also genetic risk factors and you cannot change whether you have a blood relative with dementia or a gene known to be associated dementia in older adulthood. Focus instead on the risk factors that you can control. Like the vascular ones mentioned earlier. You can take action to prevent or better manage medical conditions, such as high blood pressure for example.  MCI outcome is not certain, which is why monitoring over time (on your own and by making your doctor aware of your concerns) is important. It is also why taking action over risk factors that you can control is important.

What you can do

There are things you can do to prevent or delay MCI from progressing to dementia. Upcoming blogs will detail many options. Maintaining or improving upon healthy lifestyle habits is good general advice. Especially since there are a number of research studies linking healthy lifestyle with reduced risk of dementia. There is no magic pill. There is work involved and it starts with a capital E, yeah you got it, EXERCISE.  Channel the energy you might have put into worrying about “what if” into being proactive about your health. Next month Dr. Anderson will tell you about how physical exercise affects your memory and your risk of dementia as you age. 

Kelly Murphy, Ph.D., is a Clinical Neuropsychologist at Baycrest and an Assistant Professor of Psychology at the University of Toronto.

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