As we age, our bodies don’t always work as well as they once did. But when we notice it’s our brain that’s slowing down, it can be scary. You might wonder if it’s just normal aging or an early sign of dementia.
There’s actually a middle ground called mild cognitive impairment. These are changes beyond what a typical aging adult experiences that don’t rise to the severity of dementia.
“Normal changes occur slowly over time,” says UNC Health geriatrician Emily Cetrone, MD. “But mild cognitive impairment is more than normal aging. Something more is going on.”
Mild cognitive impairment (MCI), also called mild neurocognitive disorder, affects between 12 percent and 18 percent of Americans age 60 and older. It may have many causes, and the chances of developing MCI increase with age. Conditions including depression, anxiety, diabetes, high blood pressure, high cholesterol, certain medications, lack of sleep and stroke may contribute.
Mild Cognitive Impairment May Cause Little Impairment
Mild cognitive impairment, as the name suggests, is not a dramatic diminishment of abilities.
“People with MCI are still able to function in their day-to-day lives,” Dr. Cetrone says. “They can usually still perform at work, take care of their medications, get themselves dressed and bathed.”
The symptoms are more subtle and not always specific: People with MCI may lose things often, such as car keys or eyeglasses. They might forget to go to appointments or events. Sometimes they have more trouble coming up with words than other people their age. But these examples can also happen during normal aging.
Usually, the impairment involves one function or one way we process information, Dr. Cetrone says.
“There can be short-term memory loss,” she says. “Sometimes there is impairment in judgment; for example, a person may fall for a scam more easily. Some people may get lost—they are less able to navigate than they were previously.”
Mild Cognitive Impairment Sometimes Progresses to Dementia
In some cases, MCI is caused by a neurodegenerative disease, such as Alzheimer’s disease, that progresses to dementia. Each year, 10 percent to 15 percent of people with MCI develop dementia. Of those whose MCI is due to Alzheimer’s, about a third will develop dementia within five years.
“Experiencing these symptoms can be very alarming for people,” Dr. Cetrone says. “If you notice changes, don’t panic, but do talk to your doctor.”
Get Tested for Cognitive Changes Regularly
Most MCI is managed by a person’s primary care physician. When a patient mentions concerns about memory loss, their doctor will look for addressable causes, including sleep disorders, medications and mood disorders. They may give the patient a brief cognitive screening test in the office.
Depending on what the screening test shows, the doctor could refer the patient to a specialist for more thorough testing that may detect Alzheimer’s disease or another cause of dementia.
Importantly, once you have your memory and other brain functions tested, your doctor has a baseline to measure against over time to see if your symptoms are getting worse. Older adults are often tested annually, or more frequently if you or your doctor have concerns.
“See your doctor sooner if your symptoms are progressing rapidly—if you notice changes in weeks and not in years,” Dr. Cetrone says.
Look for symptoms such as tremors or a change in how you walk, which would suggest something more is going on.
Treatment for Mild Cognitive Impairment
Sometimes, symptoms of MCI can be managed with simple changes, such as writing things down or using a GPS navigation system.
If MCI is caused by something reversible, such as poor sleep or a mood disorder, then symptoms can get better. A person’s sleep may improve by using a CPAP machine or following sleep hygiene recommendations, and mood disorders may respond to mental health therapy or antidepressant medications.
Other times, MCI is a side effect of certain medications, and trying to minimize these medications with your doctor can help your symptoms. MCI can also occur with chemotherapy or long COVID and can gradually improve.
If a specialist determines that your MCI is due to Alzheimer’s disease, they may want to talk to you about medication options. Otherwise, treatment for MCI is focused on managing sleep, mood and medications.
“In fact, some of the most helpful ways to treat MCI are nonpharmaceutical,” Dr. Cetrone says. “Exercise, exercise, exercise. And eat a healthy diet. The things that are good for the health of your whole body are good for the health of your brain.”
Stay active mentally and socially, too, she says. Consider getting active in your community or pursuing a hobby such as gardening or playing pickleball.
Staying engaged is important, Dr. Cetrone says.
“When people retire, they suddenly have a new routine—or lack of routine,” she says. “I ask patients who are about to retire what their plan is. We can see memory symptoms progress after people retire if they have nothing going on.”
Plan Ahead for Cognitive Changes
Dr. Cetrone suggests that patients plan ahead and let friends and family know what their wishes are if their cognitive impairment progresses and they can no longer take care of themselves.
“It helps to plan and be prepared,” she says. “Get advance care plans in place, a living will. These are hard conversations to have but starting to have memory issues is extra encouragement to talk to your family. When people start noticing cognitive impairment, then they want to plan for their care while they can still understand the complexities.”
Try Not to Panic About Every Memory Lapse
It’s normal to take longer to remember some things or to think through some situations as you age, Dr. Cetrone says.
“We all forget where we put the keys, or forget words, or walk into a room and forget why we went in,” she says. “This can be seen with normal cognitive aging. Our processes slow down over time.”
Try to stay calm while monitoring any changes you notice, and ask your doctor whenever you have questions or concerns.
If you have questions or concerns about your memory or cognitive abilities, talk to your doctor or find one near you.