MCI Frequently Asked Questions

What types of dementia are the most common causes of MCI?

Globally, just over 6% of individuals in their 60’s have mild cognitive impairment (MCI), with the proportion climbing to over 37% for those aged 85 and older. MCI progresses to dementia in approximately 15% of cases. MCI may be the result of a mental health issue (e.g., depression, anxiety, stress, etc), medication side effect, thyroid or kidney problems, an infection, traumatic brain injury, vascular disease, degenerative brain disease, or other underlying health problems (e.g., lack of sleep, depression, etc.). The diverse etiology of MCI results in a broad spectrum of treatments and outcomes.

What’s the timeline of MCI?

Because MCI can be due to a variety of causes, the timeline of progression can vary drastically between individuals. MCI due to some general health conditions, such as sleep deprivation, may be reversed with behavioral changes and/or medication. Other forms of MCI, like those due to traumatic brain injury, may be stable and nonprogressive over time. The development of MCI resulting from vascular disease or stroke is ultimately dependent upon the underlying disease and the impacts of behavioral changes and treatments. Progression is most likely for persons with MCI caused by neurodegenerative disease, such as Alzheimer’s or Frontotemporal Dementia. MCI due to Alzheimer’s typically shifts to dementia within two to five years. MCI with Lewy bodies may progress to dementia even quicker.

Further complicating predictions is the fact that patients are diagnosed at differing points of disease, with some seeking care at the first signs of clinical disease and others nearing the end of MCI. Thus, the starting point of the timeline is really unknown and cannot be accurately predicted. Predictors of dementia development include poorer functioning, APOE4 genotype, higher systolic blood pressure, and lower body mass index.

What should I expect?

In addition to declines on neuropsychiatric tests, there are symptoms that often indicate a person falls within a certain stage of dementia.

Mild Cognitive Impairment

Individuals with MCI exhibit objective evidence of cognitive impairment, distinguished from normal aging and indicative of a decline from past abilities. Despite their impairment, persons with MCI are able to function nearly independently in their daily lives.

Early-Stage Dementia

As MCI shifts in to mild dementia, the patient may take longer to accomplish normal daily tasks or require more assistance; have trouble handling money and paying bills; experience confusion in familiar places; exhibit poor judgment; and have mood and personality changes. Persons with early -stage dementia exhibit low performance in more than one cognitive domain; however, they are able to manage their activities of daily living (bathing, dressing, personal hygiene).

Moderate Dementia

In moderate stages, persons with dementia experience increasing memory loss and confusion, impairment in language, difficulty learning new information or managing unexpected situations, and increasing disorientation about time and place. They may become withdrawn or more easily agitated, and they may be susceptible to depression or personality changes. Sleep patterns may shift, with more napping during the day and restlessness at night. Individuals in moderate dementia stages can still participate in their activities of daily living; however, they may require some minor assistance or need to simplify tasks to complete them.

How can I best prepare for sudden changes in my loved one’s behavior?

Sudden acute changes or distress should always be reported to the patient’s treatment team as a potential medical concern. While it may be challenging to notice subtle changes, in general, you may observe more “tough days”: those times when your person needs more prompting to do even familiar tasks; days when they complete activities slower and/or the overall quality of the job done is lower (ie, contains more errors). Perhaps they used to have difficulty mainly with complex, multi step tasks, but the simpler ones are becoming harder to negotiate too. The individual may appear to get frustrated more easily or intensely than in times past. Difficulties that become severe enough to significantly interfere with daily functioning define Dementia. As Care Partner, your observations are the most reliable way to assure you are providing the support the person with Cognitive Impairment needs to remain safe and as engaged in meaningful activities as they can if the condition progresses. More detailed information is at https://www.nia.nih.gov/health/what-mild-cognitive-impairment from (ADEAR) National Institutes on Aging Alzheimer's & related Dementias Education and Referral Center [1-800-438-4380, M-F, 8:30 am-5:00 pm EST] or email to adear@nia.nih.gov.

What can we do to slow or stop the progression?

Since there are many causes of dementia, it is important to speak with your neurologist about the most appropriate treatment options for the patient to pursue.

The Alzheimer’s Association offers a detailed outline of drugs that may be appropriate for persons with Alzheimer’s disease:
Medications for Memory, Cognition and Dementia-Related Behaviors

Many patients and families are interested in learning more about Aduhelm (aducanumab), which was approved by the FDA in June 2021. Emory Healthcare does not currently have aducanumab available. Once it becomes available, we will begin reaching out to patients who may be eligible. However, additional delays of several months are still expected. Thank you for your patience as we work with our teams on setting up a safe workflow to deliver aducanumab to our patients. 

The Alzheimer’s Association also has a comprehensive site detailing treatments targeted to individuals with vascular dementia:
Vascular Dementia

The University of Pennsylvania Perelman School of Medicine offers a comprehensive description of treatments available for individuals with frontotemporal degeneration:
Common Medications and Treatments