Definition

Mild cognitive impairment (MCI) is a cognitive disorder that goes beyond normal age-related changes. However, the individual's daily activities remain normal, and the symptoms do not meet the criteria for dementia. MCI is a warning sign that the affected individuals have a higher risk of developing Alzheimer's dementia. The incidence rate of mild cognitive impairment ranges from 12-18% in people over 60 years old each year, and this rate tends to increase with age.

Causes

The causes of mild cognitive impairment vary widely. Often, mild cognitive impairment with symptoms of forgetfulness is associated with Alzheimer's disease. This is evident as most such cognitive impairments develop into Alzheimer's disease within 6 years. Meanwhile, mild cognitive impairment with signs other than forgetfulness can be caused by vascular disease, Lewy body dementia, Parkinson's disease, frontotemporal dementia, and others.

In Alzheimer's disease, there is an accumulation of beta-amyloid protein (plaques) and tau protein (tangles) that can damage brain nerves. Meanwhile, in Lewy body dementia, other proteins clump in the brain nerve cells. Vascular damage can also cause mild cognitive impairment.

Risk factor

The most common risk factor for mild cognitive impairment is aging. Additionally, a family history of Alzheimer's can also increase your risk of experiencing mild cognitive impairment. Other risk factors may be related to vascular conditions, such as diabetes, smoking, high blood pressure, increased cholesterol levels, and obesity. Depression can also be a risk factor for mild cognitive impairment. Other risk factors include lack of physical activity, low education, and rarely engaging in mentally and socially stimulating activities.

Symptoms

Symptoms of mild cognitive impairment are often difficult to recognize and are subjective. Common symptoms include:

• Forgetfulness
• Easily forgetting appointments
• Losing track in conversations, reading books, or watching movies
• Difficulty making daily decisions
• Getting lost in familiar places
• Being impulsive and making often immature decisions

These disorders are often noticed by friends or family. Rare cognitive disorders can include speech disorders (such as difficulty choosing words), decreased attention (such as difficulty following or focusing on conversations), and decreased visual-spatial abilities (such as getting lost in familiar environments). However, it is important to note that these symptoms do not significantly interfere with daily work.

Diagnosis

Mild cognitive impairment is generally recognized by those around the sufferer. If you are accompanying someone suspected of having mild cognitive impairment, you may be asked about the chronology of cognitive function changes, changes in self-care abilities (such as bathing and eating), financial management abilities, physical symptoms such as nausea, vomiting, loss of balance, numbness, or paralysis, psychiatric changes such as mood, behavior, and personality changes, and medication history.

Additionally, the doctor may perform neurological examinations to ensure there is no acute condition such as a stroke causing mild cognitive impairment. This examination can include mental status, head nerve examination, tactile and motor functions, reflexes, limb coordination, balance, and gait. The doctor will also conduct tests to assess cognitive function, such as counting, naming objects, remembering objects, and more.

The doctor may also perform laboratory tests to identify treatable causes of mild cognitive impairment, such as hypothyroidism (decreased thyroid hormone levels) and low vitamin B12 levels. Other tests can include complete blood tests, cholesterol tests, blood sugar tests, and blood chemistry, urine analysis, and liver and kidney function tests.

Imaging tests are rarely performed but CT scans and magnetic resonance imaging (MRI) can be used to rule out possible brain tumors, bleeding, or stroke.

Management

Currently, there is no treatment for mild cognitive impairment. However, several measures can be taken to address treatable causes of mild cognitive impairment, such as the use of medications and other conditions. If you are taking anti-anxiety medications, nerve medications, allergy medications, or stomach acid-lowering medications, consider discussing their use with your doctor. You can stop using these medications as advised by your doctor.

Other conditions that can cause mild cognitive impairment include high blood pressure, depression, and sleep apnea. If you experience these conditions, you can visit a doctor for treatment. High blood pressure can be controlled with medication and dietary adjustments. Meanwhile, depression requires psychological therapy and social involvement for improvement, as well as antidepressants. If you snore during sleep, along with frequent waking up due to shortness of breath, it is advisable to see a doctor for further treatment. If you are overweight, achieving an ideal weight can help address the snoring issue.

You can also take these measures at home to prevent worsening cognitive impairment:

• Regular physical activity benefits heart health and slows cognitive decline.
• A low-fat, high-fiber diet benefits the heart and helps protect cognitive health.
• Omega-3 fatty acids are also good for the heart due to their unsaturated fat nature.
• Intellectual stimulation can slow cognitive decline, such as using computers, playing puzzles, reading books, etc.
• Social activities can make life more enjoyable, maintain mental function, and slow cognitive decline.
• Memory exercises and other cognitive exercises can help improve cognitive function.

Complications

Complications of mild cognitive impairment include progressing to severe cognitive impairment or even dementia. In dementia, symptoms can lead to cognitive decline that disrupts daily activities. People with dementia are highly dependent on others which can lead to disability and death.

Prevention

Mild cognitive impairment is not always preventable, but several measures can be taken to prevent cognitive impairment:

• Avoid excessive alcohol use.
• Limit exposure to air pollution.
• Reduce the risk of head injuries by adhering to safety rules while exercising, driving, working, etc.
• Avoid smoking.
• Control chronic diseases such as diabetes, high blood pressure, and lose weight if obese, and seek help for depression recovery.
• Practice sleep hygiene to improve sleep quality.
• Consume a high-fiber, low-saturated-fat diet.
• Be active in social activities.
• Engage in regular physical activity with moderate to high intensity.
• Use hearing aids if you have hearing impairment.
• Stimulate the brain with puzzles, games, and memory exercises.

When to see a doctor?

See a doctor immediately if you or someone around you seems to have difficulty remembering things, counting, making decisions, getting lost in familiar places, or experiencing mood changes such as irritability or lack of enthusiasm. These symptoms are often underestimated but can be early signs of mild cognitive impairment. Untreated mild cognitive impairment can progress to dementia. It should be noted that dementia is the seventh leading cause of death worldwide and one of the most common causes of disability in the elderly.

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