Is My Forgetfulness Normal: When to Be Concerned?

As we age, our bodies experience changes that are typical signs of aging, such as reduced vision or sore joints. Our brains also age, so forgetting where you left your keys could be an ordinary sign of aging. However, if you repeatedly misplace your keys and forget to pay your bills, at what point do you need to be more concerned?

Could the increase in memory problems indicate a more concerning matter referred to as Mild Cognitive Impairment?

What is Mild Cognitive Impairment?

Mild Cognitive Impairment (MCI) is a medical diagnosis indicating a person has increased difficulty with their memory or thinking beyond "normal aging." People with MCI usually live independently and carry out their daily lives with minimal problems, as it is not as severe as dementia.

The risk of MCI increases with aging, with an estimated 2% to 18% of people over age 60 having some mild cognitive impairment. People with MCI don’t necessarily progress to dementia, but it does increase the risk. Research from the National Institute on Aging shows that 10% to 20% of people diagnosed with MCI will develop dementia over a year. Others with MCI may remain stable and never progress; others may improve.

Risk factors for MCI are similar to Alzheimer’s and other dementias, including carrying the APOE-e4 gene associated with the development of Alzheimer's disease. In addition, some brain autopsies of people with MCI have shown changes related to Alzheimer's, including beta-amyloid plaques and clumps of tau proteins. Also detected in some autopsies of people with MCI are Lewy bodies, a protein associated with Parkinson's disease and Lewy body dementia.

MCI has two sub-classifications: Amnestic MCI, where cognitive impairment is mainly associated with memory difficulties like forgetting dates and appointments. The other, called Non-Amnestic MCI, is more concentrated on the decline in basic thinking skills, such as misjudging the steps needed to complete a specific task.

Possible causes of MCI

• Neurodegenerative disease associated with early signs of dementia.
• Vascular brain issues like a stroke or traumatic brain injury.
• Diabetes or heart disease.
• Alcohol or drug abuse.
• Reversible conditions such as the side effects of medication, depression, or anxiety.

Signs of MCI

• Missing necessary appointments or social events.
• Misplacing or losing things more often.
• Increasing difficulty coming up with the right words.
  
• Difficulty making decisions.
• You become overwhelmed managing steps to complete a task.
• You lose your “train of thought” more often while talking, reading, or watching a movie.

A medical practitioner determines the diagnosis of Mild Cognitive Impairment. Therefore, if you have concerns about yourself or your loved one, you must make an appointment with your healthcare provider for a prompt investigation.

A thorough medical and functional history obtained from the patient and a family member is essential for the assessment. Cognitive screening, labs, and imaging such as computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan may also help to determine the cause of memory impairment.

Treatment

While there is no specific treatment for Mild Cognitive Impairment, strategies and lifestyle modifications may manage symptoms to delay the progression of further decline. For example, appropriate medical interventions can treat the source of cognitive decline due to hypertension, depression, sleep apnea, or side effects of medications. This may reverse the deterioration in cognition. Your medical practitioner will determine the proper course of treatment.

However, when early changes suggest a degenerative neurological cause, your healthcare provider should monitor cognitive and functional status every six to 12 months. Ongoing monitoring may detect any further decline suggesting progression to dementia. Cholinesterase inhibitors, used in the treatment of dementia, are not routinely prescribed for Mild Cognitive Impairment, as the evidence does not show enough improvement to support it.

Strategies to manage Mild Cognitive Impairment

• Use “to-do” lists to manage daily routines.
• Use medication reminder systems such as compliance packaging or smartphone alarms.
• Keep your calendar or date book updated and make notes.
• Keep frequently used items such as keys or wallets in the same place.
• Reduce or avoid drinking alcohol.
• Exercise your mind by learning a new skill.
• Maintain social connections with family and friends.
• Maintain physical exercise and eat a balanced diet.
• Get enough sleep (ideally seven to eight hours.)
• Consider a professional counselor specializing in cognitive decline to learn skills to manage lifestyle changes and future planning.

MCI programs

If you or your loved one has a diagnosis of MCI, lifestyle programs are available for education and support. The Alzheimer's Association has several virtual and in-person early-stage programs for individuals with MCI and their family members/caregivers.

The Mayo Clinic also has a "HABIT" program, Healthy Action to Benefit Independence & Thinking, held at Mayo Clinic sites throughout the US. These and other programs teach skills to maintain independence for as long as possible.

Having Mild Cognitive Impairment does not mean you will develop dementia. Investigation and ongoing monitoring by your medical practitioner are paramount to detecting early changes that could suggest early dementia. Managing an active social and healthy physical lifestyle is the best protection against further cognitive decline in anyone as they age, especially for those with Mild Cognitive Impairment.