Evaluating MCI (Mild Cognitive Impairment)

Losing things, forgetting appointments, trouble coming up with words. These may be signs of Mild Cognitive Impairment, or MCI. MCI is a condition that some older adults experience in which they have more memory or thinking problems that other adults their age. Symptoms suggestive of MCI are less pronounced than symptoms of Alzheimer's disease or other type of dementia but should still be evaluated by a doctor.

Diagnosing MCI

The primary objective of an evaluation should be to distinguish MCI from normal aging or dementia and to look for underlying causes that are potentially reversible. Establishing the cause and scope of the impairment is helpful in setting a baseline for future cognitive evaluations.

The journey toward a diagnosis of MCI is most often initiated by a person's subjective complaint about memory and thinking problems or by concerns expressed by those closest to the individual. This is an important distinction because cognitive changes that are readily apparent to the broader outside world are more likely to signal that the person is suffering from dementia. In addition, people who have progressed into Alzheimer's disease are often not aware of their memory lapses. 

Your regular doctor is a good place to start the process because he or she knows you and your medical history. However, you may need to pursue evaluation a doctor who specializes on cognitive function, such as a behavioral neurologist or a geriatric psychiatrist. Your local Alzheimer's Association chapter, medical school, or hospital can help direct you to an appropriate specialist.
Initial medical evaluation

Before evaluating your cognitive health, your doctor will first want to understand if your memory problems are a symptom of an underlying health problem. He or she will then do a physical exam, focusing on the nervous system and also evaluating possible vision or hearing abnormalities that can contribute to cognitive impairment.
Your doctor will likely order a complete blood count and blood chemistry tests to detect anemia, infection, diabetes, and kidney and liver disorders. Other lab work will include routine tests for thyroid function, vitamin B12 deficiency, and elevated blood calcium. 

If the physician suspects a specific medical problem, additional tests may be needed. Your doctor will also want to review all the medications you take, to see if any of these drugs may be causing cognitive symptoms.

Cognitive function evaluation

The doctor will start this evaluation with a detailed history of your cognitive changes over time. It is important for a family member or close friend who knows you well and is familiar with your medical history, current symptoms, and concerns to be present to help corroborate your recollections. 
Certain features in your history can be telling. For example, cognitive decline that takes place rapidly— over weeks or months—is not typical of changes in brain structure involved in MCI or Alzheimer's disease. Instead, it may indicate a problem such as a tumor or metabolic irregularity.

Neuropsychological testing

You may be referred to a psychologist with specialized training in brain disorders for comprehensive neuropsychological tests. These tests may take the form of interviews, paper-and-pencil tests, or computer-based tests. The tests are designed to assess memory, reasoning, attention, language, visual functions, motor functions, and social functions (such as empathy and knowing how to behave appropriately in social situations). You may also be given other tests to identify depression, anxiety, and other mood problems.

Brain imaging

A brain scan using either computed tomography (CT) or magnetic resonance imaging (MRI) may be done to examine the anatomic structure of the brain. These scans are used to rule out such problems as tumor, infection, bleeding, stroke, and hydrocephalus (excess fluid in the area around the brain). 

Sometimes additional testing such as functional brain imaging or an amyloid PET scan may be suggested. These tests tend to be expensive and may not be covered by your health insurance.

To learn more about MCI, reducing its impact, and possibly preventing it from happening at all, check out the online guide from Harvard Medical School, Understanding Mild Cognitive Impairment.

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