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What is Mild Cognitive Impairment? 

Learn about mild cognitive impairment and how it is different from normal aging.

15 minutes

Lesson Outline

Mild cognitive impairment, or MCI, is also sometimes called mild neurocognitive disorder. It is a condition characterized by noticeable, but not severe, cognitive decline that is greater than expected for a person's age, yet not significant enough to interfere with daily functioning. It involves difficulties with memory, attention, language, or executive function, but individuals with MCI can generally still perform most daily tasks independently.


After completing this interactive lesson, you should be able to answer the following questions:

  • What is mild cognitive impairment?
  • How is it different from normal aging and dementia?
  • What causes it, how is it diagnosed, and are there treatments?
15 minutes


⏱ 6 min read

What are the normal cognitive changes associated with aging?

The changes associated with normal aging are subtle. For instance, someone forgetting what they ate for breakfast by lunchtime would never be associated with normal aging.

As we age, some of our cognitive abilities gradually decline.

  • We can’t remember quite as much when learning new information and it may take a little longer to retrieve information, but it isn't absent.
  • We don’t process things quite as fast, so it may take longer to perform tasks, solve problems or react.
  • Learning more complicated tasks becomes more difficult, such that planning, organizing, or making decisions about complex situations might take more time, but day-to-day decisions are still manageable.

Not all changes associated with normal aging are negative. We continue to make lifelong memories, and even our vocabulary and wisdom may continue to improve later in life. Knowledge and skills acquired through education and experience may improve problem-solving, decision-making and judgement in some contexts.

Some degree of cognitive decline is normal and expected as we age, however, the changes associated with natural aging don’t impact a person’s ability to function independently. Despite these minor cognitive changes, individuals typically retain a good cognitive reserve, meaning they can rely on accumulated knowledge, experience, and strategies to compensate for minor cognitive lapses.


How is mild cognitive impairment different from normal aging?

With mild cognitive impairment, there is a modest decline in one or more cognitive domains that is more pronounced than what is seen with normal aging but not as severe as dementia.

The following table highlights the key differences:

 

Cognitive DomainNormal AgingMild Cognitive Impairment
MemoryMild forgetfulness (e.g., occasionally forgetting names or where something was placed).Noticeable memory problems, particularly with short-term memory (e.g., forgetting recent conversations or appointments).
AttentionSlightly reduced attention span, but still able to focus when necessary.Difficulty with sustained attention and multitasking, often resulting in errors or slower response times.
Executive FunctionMild difficulty with complex planning or decision-making, but can still manage daily tasks.Difficulty with executive functions like planning, organizing, and problem-solving, affecting daily activities.
LanguageOccasional word-finding difficulties, but can usually find alternatives.Frequent word-finding difficulties, reduced fluency, and sometimes noticeable language comprehension issues.
Processing SpeedSlightly slower cognitive processing (e.g., slower recall), but manageable.Slower processing speed, especially in complex or new tasks. Takes longer to complete tasks.
Motor FunctionNo significant motor changes; movement is typically unaffected.No significant motor changes, though motor coordination may be impacted in some cases (less common in MCI).
Judgement and Problem-SolvingMild difficulty with complex decisions, but generally able to solve daily problems.Impaired judgement and problem-solving, especially in unfamiliar or complex situations.
Daily FunctioningIndependent in all activities of daily living (ADLs).Still able to perform ADLs but may require occasional reminders or assistance for more complex tasks.

 

How is mild cognitive impairment different from dementia?

Mild cognitive impairment differs from dementia in that the cognitive changes seen in mild cognitive impairment are less severe, and everyday functioning is less impaired. People with mild cognitive impairment can still perform tasks such as banking, grocery shopping, and enjoying hobbies, although these tasks may take longer and require more effort. In contrast, dementia involves cognitive decline to the point where it significantly impairs independence in everyday activities and complex tasks are likely too hard to do.


What causes it?

Mild cognitive impairment can be caused by many of the same factors that lead to dementia. It can often be hard to find the cause, but it’s important for a health care team to do a full assessment to try to manage any underlying causes.

If toxic proteins, like those in Alzheimer disease, are the cause, the cognitive decline is more likely to continue. Blood vessel damage, like that from a stroke, may also be a cause, and additional treatments might be recommended to prevent further damage.

It's important to have a proper medical assessment to rule out other potentially reversible causes of cognitive impairment that might look like MCI. This includes conditions like depression, thyroid disease, vitamin B12 deficiency, substance use disorders like alcohol use disorder, medication side effects, and others.

 

How is it diagnosed?

Mild cognitive impairment is diagnosed by a physician, often after a person reports memory and thinking problems. The assessment should include taking a detailed history of the problem from the person as well as from a close friend or family member, a physical exam, cognitive testing, and other tests, such as blood tests or brain imaging, as required to assess for other medical conditions that might be affecting cognition.

 

Are there treatments?

Unfortunately, there is no targeted therapy for mild cognitive impairment caused by toxic proteins or blood vessel damage. However, general brain health can be improved through a combination of diet, exercise, social activity, and managing blood vessel health, such as controlling blood pressure, cholesterol and diabetes. Social and cognitive activities are also beneficial.

Potentially reversible causes that might be affecting cognition should also be identified and managed. For example, if cognitive symptoms are due to depression or a vitamin B12 deficiency, appropriate therapies can improve cognition. Changes in medication or reducing alcohol intake can also help if these are contributing factors. Having your health care provider or pharmacist review your medications may help to identify those that can contribute to cognitive adverse effects like memory problems.

 

Other strategies for managing mild cognitive impairment

People with mild cognitive impairment are often asked to see an occupational therapist to help them come up with coping strategies to help manage deficits. Keeping a journal to write down appointments, conversations, and events can be useful. Setting reminders or alerts on smartphones and using pre-filled medication tools like blister packs can help manage daily tasks. Avoiding stressful situations, simplifying tasks, and not multitasking can also reduce the impact of cognitive problems.

 

What should you do if diagnosed?

If you are diagnosed with mild cognitive impairment, it is important to maintain a positive attitude and use support from family, friends, and community resources. Being proactive is beneficial, such as arranging insurance, wills, and power of attorney to ensure that your loved ones are taken care of in case your cognitive function declines further. This is good advice for everyone as they age but is particularly important for those with mild cognitive impairment due to the higher risk of developing more severe memory and thinking problems in the future.

 

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Authors

Anthony Levinson

Anthony J. Levinson, MD, MSc, FRCPC

Neuropsychiatrist, Professor; Faculty of Health Sciences, õ

Dr. Richard Sztramko

Richard Sztramko, MD, FRCPC

Consultant Geriatrician and Internist, Vancouver Coastal Health

About this Project

Who authored and edited this page?

This page was developed by the Division of e-Learning Innovation team and Dr. Anthony J. Levinson, MD, FRCPC (Psychiatry) and Dr. Richard Sztramko, MD, FRCPC (Internal Medicine, Geriatrics). 

Dr. Levinson is a psychiatrist and professor in the Department of Psychiatry and Behaviour Neurosciences, Faculty of Health Sciences, õ. He is the Director of the Division of e-Learning Innovation, as well as the John Evans Chair in Health Sciences Educational Research at õ. He practices Consultation-Liaison Psychiatry, with a special focus on dementia and other cognitive and mental disorders in the medically ill. He is also the co-developer, along with Dr. Sztramko, of the  dementia care partner resource, and one of the co-leads for the õ Optimal Aging Portal. He and his team are passionate about developing high-quality digital content to improve people's understanding about health. 

Dr. Sztramko is a consultant geriatrician and internist for Vancouver Coastal Health who also completed a fellowship in Behavioural Neurology at the University of California San Francisco (UCSF). Through his work with patients with dementia and their families, Dr. Sztramko came to understand that there is a desire and need for online education about dementia that has been developed by experts in geriatrics. This inspired him to pursue the creation of iGeriCare, on which this content is based.

A team of experts in geriatrics and mental health reviewed the content for accuracy, and care partners of people living with dementia participated in the design and development of the content on iGeriCare.

Are there any important disclosures or conflicts of interest?

Dr. Levinson receives funding from õ as part of his research chair. He has also received several grants for his work from not-for-profit granting agencies. He has no conflicts of interest with respect to the pharmaceutical industry; and there were no funds from industry used in the development of this content or website.

Dr. Sztramko has no conflicts of interest to disclose with respect to development of this content.

When was it last reviewed?

November 29, 2024.

What references and evidence were used to create this content?

The content was written and adapted by experts in geriatrics and neuropsychiatry based on credible, high-quality, evidence-based sources such as the National Institute on Aging, National Institute of Neurological Disorders and Stroke, American Academy of Neurology, National Institutes of Health, the American Psychiatric Association and the DSM-5 TR (2022), Health Quality Ontario quality standards, Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia (2020), the Cochrane Library, the Alzheimer Society of Canada, UptoDate®, the World Health Organization (WHO), and others.

Who funded it?

The initial development of some of this content was funded by the Centre for Aging and Brain Health Innovation (CABHI), powered by Baycrest, along with additional support from the Hamilton Health Sciences Foundation and Geras Centre for Aging Research. Subsequent funding was through support from the õ Optimal Aging Portal, with support from the Labarge Optimal Aging Initiative, the Faculty of Health Sciences, and the õ Institute for Research on Aging (MIRA) at õ. There are no conflicts of interest to declare. There was no industry funding for this content.