Mary Jordan - Coping with Mild Cognitive Impairment (MCI): A Guide to Managing Memory Loss, Effective Brain Training and Reducing the Risk of Dementia

COPING WITH
MILD COGNITIVE
IMPAIRMENT (MCI)

A Guide to Managing Memory
Loss, Effective Brain Training and
Reducing the Risk of Dementia

MARY JORDAN

Mild cognitive impairment (MCI) is considered to be simply a descriptive term for impaired memory or slight impairments in other areas of brain function such as planning or attention span. In some countries cognitive impairment is used instead of the term dementia to refer to a specific diagnosis where there is a memory problem and evidence of brain atrophy. In the UK the term dementia would be used to describe this and so, in this book it is reserved to refer to this condition.

Dementia is not the same as MCI. Because it is not a disease or a medical condition, strictly speaking, you cannot have a diagnosis of MCI. At the present time in the UK, MCI is not considered to be a medical condition or disease.

People who have MCI may take longer to do tasks or to plan and order a major action, but they do not experience significant problems in carrying out the functions of everyday living.

What does the term functions of everyday living mean? It simply means the things you have to do to carry on your daily life such as washing, dressing, preparing a meal, doing the shopping and so on, and also includes more complicated things like managing finances or planning a holiday. People who have MCI are still able to do all these things and are capable of living alone independently and managing ordinary everyday activities. They may take more time than others to come to a decision or take longer to plan and carry out actions, but they are not unable to manage these functions of everyday living.

Someone with MCI may have some difficulties with planning something like a social event or an outing, and may take longer to organize it. It can also be more difficult for someone with MCI to plan for the future for example, to think about changing electricity supplier or moving money into a different savings account. This doesnt mean that someone with MCI is unable to do these things it is simply that it may be more difficult for them to do so or it may take them a bit longer to arrange. People with MCI may also have more difficulty recalling things like the names of people, places or items, but given time, and when not under stress, they will likely be able to manage recall, perhaps with some reminders.

MCI can be defined as cognitive impairment, especially short-term memory loss which is beyond what would be expected given age and level of education but which is not significant enough to interfere with the activities of everyday living.

MCI is not just to do with getting old. This is important because memory problems, confusion and attention difficulties are often simply written off as problems of ageing. Many of us take longer to do things as we age, we think more slowly, we move more slowly and (perhaps due to frailty) we may be unable to complete some actions. But look again at the above definition: MCI is cognitive impairment that is considered to be beyond what would be expected given age and level of education . Being less agile and thinking more slowly may be age-related, meaning that this is what we might expect of an older person, but taken alone, these conditions are not evidence of MCI.

This book is not supposed to replace medical advice; if you are worried that you are developing dementia, please consult your doctor. They may then refer you for further investigations. If, eventually, you are diagnosed with some form of dementia, help and support is available.

There is genuine confusion amongst non-medically trained people with respect to the difference between dementia and MCI, and so the following information should help distinguish between the two conditions.

People who have dementia will have a noticeable decline in communication, learning, remembering and problem-solving. This decline may occur very slowly over time and so the symptoms may be noticed first by a friend or relative who has not been in contact for a while.

These are the sorts of symptoms that occur with dementia:

Short-term memory loss: this means forgetting something that was said or done within a few minutes. The first indication may be often-repeated questions to which the answers have already been supplied. For example, Where are we going this morning? Sometimes an observer may notice that stories are constantly repeated and the speaker has no recollection of having told the story even a few minutes before.

Impaired judgement: this can mean something like perhaps taking risks when driving or trying to carry out a task clearly beyond the persons ability. People who do not have dementia may be stubborn if advised not to undertake an activity, but they would usually recognize that the advice given is correct. Someone who has dementia may not even understand that they are taking a risk or attempting something beyond their abilities.

Difficulties with abstract thinking , such as being unable to plan for a future occasion organizing a holiday, for example: this can sometimes be masked by the person with cognitive problems simply agreeing with whatever is suggested. Relatives may just think that the person in question has become more passive or less contentious. Sometimes the person who has this problem will put off taking actions or making plans and suggest that they will do it tomorrow or perhaps tell you that they are too tired to tackle the task at this particular moment. Indeed, unusual procrastination can be one of the first signs to make relatives think something is wrong.

Faulty reasoning: this is using illogical arguments to make a point or suggesting that something has happened that is highly unlikely. A common symptom is the mislaying of an item such as a purse or set of keys. When the item is found (after an extensive search) in a strange place (under the bed is a common example), the person with dementia will claim that they had nothing to do with the loss and suggest that someone has deliberately hidden the item. This kind of illogical argument might be used even if the person lives alone and no one else has access to their belongings.

Inappropriate behaviour , such as walking to the head of a queue rather than waiting in turn, interrupting a conversation, choosing to go out in unpleasant weather, and wearing clothes unsuited to the occasion or climate.

Loss of communication skills: this can take many forms such as difficulty in expressing a point, losing the thread of a sentence, needing simplified answers to questions or failure to initiate conversation.

Disorientation to time and place , such as losing the way in familiar surroundings, getting up and dressed during the night without reason, or going to bed at inappropriate times.

Gait, motor and balance problems: this is not a common symptom but can manifest with some forms of dementia; a shuffling walk may be present or unexplained falls may be frequent. (Be aware, however, that these are also symptoms of other illnesses.)

Neglect of personal care hygiene and safety , such as failure to bathe or wash, forgetting to undress before getting into bed, neglecting to launder clothing, ignoring traffic signals when out driving, or stepping out into traffic on busy roads.

Hallucinations, abnormal beliefs, anxiety and agitation: some people become very anxious and exhibit mild paranoia before any other symptoms. A few forms of dementia manifest with hallucinations in the early stages. (Be aware, however, that these may also be symptoms of other conditions.)