A mild cognitive impairment diagnosis can be frightening

Experts say there are ways to manage and treat cognitive decline, especially if it’s caught at an early stage.

Mild cognitive impairment can be a precursor to dementia. People who have MCI show signs of memory loss and other cognitive problems that are beyond what might be considered normal age- related decline, but they are still able to function independently.

Receiving a diagnosis of MCI can cause people a lot of anxiety, but catching cognitive decline allows the person to take an active role in determining what they want the next phase of their life to look like, said Dr. Carolyn Fredericks, an assistant professor of neurology at Yale School of Medicine.

“It can be helpful for families to know what to expect and to start all that legal and financial planning,” Fredericks said. No one wants to think about that, she added, “but it’s so much better done when somebody is clear of mind and can contribute what they want.”

What’s more, while people with MCI may go on to develop Alzheimer’s disease or other dementias, the progression is not a guarantee. Treating MCI can “prolong that period of being independent by months or years,” said Andrew Kiselica, a neuropsychologist at the University of Missouri who specializes in diagnosing dementia.

The first step to treating MCI is to search for a biological reason for someone’s symptoms using blood tests, brain scans and other clinical assessments. Many cases of MCI are caused by neurodegenerative diseases, but there are other conditions that can affect cognition, including sleep apnea, depression, hearing loss, cirrhosis of the liver or a vitamin deficiency. “Those sorts of things may be potentially addressed with treatment and potentially reversible,” Kiselica said.

Even if the root cause for MCI is a neurodegenerative disease, taking care of some of these “exacerbating causes” can help improve symptoms, said Dr. Halima Amjad, an assistant professor of medicine specializing in geriatrics at the Johns Hopkins University School of Medicine. A doctor might swap out medications that are causing brain fog or other cognitive side effects, or fit a person for hearing aids so they can be more socially engaged. “They might not be the only cause,” she said, “but if they’re making cognition worse, let’s make it better.”

Evidence also suggests that lifestyle interventions, particularly exercise and diet, can slow cognitive decline. “It’s almost a cliché for a doctor to say you need to eat right and exercise,” Fredericks said. “But we have a lot of really good data that, especially in the very earliest stages of illness, things like a significant amount of cardiovascular exercise, like eating a Mediterranean diet” can be very helpful for cognition, as well as quality of life. Experts typically recommend 150 minutes of moderate intensity or 90 minutes of vigorous intensity aerobic activity per week, plus two days of resistance training.

Drugs called cholinesterase inhibitors have been used to treat dementia for years. These medications block the breakdown of a common neurochemical called acetylcholine that is important for attention and memory. They don’t address the underlying causes of the disease, but they can help improve symptoms.

However, these drugs are only approved to treat dementia, and there is little evidence to suggest they are beneficial for people with MCI. The American Academy of Neurology does not officially recommend the drugs for MCI, though doctors can prescribe them off label.

The key deciding factor, she added, is whether the MCI is related to Alzheimer’s disease, because there is more evidence to support their use in that scenario.