Living With Mild Cognitive Impairment

How to maximize brain health and reduce the risk of dementia

What's in a Name?

Mild Cognitive Impairment by any other name....

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Changes to the name and definition of mild cognitive impairment (or MCI) are on the horizon. However, as in Juliet’s declaration that a rose by any other name would smell as sweet, does it really matter what we call MCI? Or, regardless of the name, is MCI still MCI?

Introducing the DSM-5

Last month, the long-awaited 5th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released at the annual meeting of the American Psychiatric Association. Sometimes referred to as the bible of psychiatry, the DSM-5 describes symptoms of virtually all mental health and cognitive disorders. It is used by health professionals to diagnose conditions ranging from learning disorders to schizophrenia to insomnia and everything in between.

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New to this version of the DSM-5 is the official recognition of a category of cognitive disorders that are mild in nature and don’t meet criteria for more serious cognitive problems like dementia or amnesia. This mild state of cognitive change has been given the name mild neurocognitive disorder, or mild NCD, and is similar to the idea of MCI. It is contrasted with major NCD, which describes a more severe cognitive disorder, similar to the term dementia.

What’s new for MCI?

So, is MCI by any other name still MCI? According to the DSM-5, the answer to this question is more or less yes. The text of the DSM-5 describes MCI as “substantially congruent” with mild NCD. And, if you look closely at the criteria used to diagnose MCI and mild NCD, you will indeed notice many similarities.

The defining features of both MCI and mild NCD include the presence of a mild problem in some area of cognition such as memory, and the problem has to represent a decline over time. An important part of both diagnoses is that the cognitive problem is not severe enough to interfere with the person’s ability to be independent in their day-to-day activities. Both definitions also state that other medical conditions can’t be the cause of the memory problem, although the specific conditions vary between the two definitions.

The bottom line is that the definitions of MCI and mild NCD share many commonalities and few differences. In other words, if you meet criteria for MCI, you likely also meet criteria for mild NCD, and vice versa.

Which name to use

Unlike Romeo, who would be defying generations of tradition to change his name, it is not uncommon for medical and cognitive disorders to be given new monikers every few decades or so. Only time will tell whether clinicians and those with mild forms of cognitive decline will adopt the new term mild NCD or stay with the more familiar MCI.

In the meantime, mild cognitive impairment by any other name will remain essentially the same: a set of symptoms characterized by mild cognitive decline that doesn’t substantially impact a person’s day-to-day functioning. Also in the meantime, what you call it is up to you.

Angela Troyer, Ph.D., is the Professional Practice Chief of Psychology and Program Director of Neuropsychology and Cognitive Health at Baycrest and Assistant Professor of Psychology.

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