Update on Mild Cognitive Impairment

By Sondra Forsyth

A new comprehensive review of studies about mild cognitive impairment (MCI) says that physical and mental activity can help reduce the risk of the frightening condition.

The doctors, from the University of Michigan Medical School, published their review in the Journal of the American Medical Association.

“MCI is hard for both clinicians and for patients and their families, because it’s a scary prospect – and because there’s still a lot we don’t know about this condition,” says Kenneth Langa, M.D., Ph.D., who co-authored the article with U-M colleague Deborah Levine, M.D., MPH. “We still don’t have great answers to give patients and families, but the medical literature shows there are certainly factors that can influence the risk, severity, and progression of MCI. We hope this review will spread awareness of those, and help guide patient care.”

Levine said although there aren’t any medicines to successfully treat MCI, “our review shows good evidence that aerobic exercise, mental activity, social engagement, and stroke prevention help reduce the risk of further cognitive decline.”

The paper provides doctors with a guide for what to do when a patient or caregiver mentions memory or thinking problems. Tests for vitamin deficiencies, standards cognitive tests, and physical and neurological exams can help provide answers.

As for patients, the literature indicates they should be both physically mentally active. A number of studies have indicated that this can have a small beneficial effect.

According to the review, patients should:

Work to reduce risk factors for stroke. Control high blood pressure, stop smoking and lower cholesterol with statins. Taking aspirin and other medicines to prevent blood clots can also help.

Keep body and brain active. A number of studies have indicated that aerobic exercise and mental activities can have a small beneficial effect on thinking ability in older adults with MCI.

Be on the lookout for multiple medicines. The physicians said that studies have revealed that drugs can interact with each other and affect memory and thinking.

Avoid over-treatment of high blood pressure and diabetes. “It is important to avoid overtreatment of high blood pressure and diabetes because low blood pressure and low blood sugar may increase the risk of cognitive decline and other patient harms,” says Langa.

Although many people understandably worry that MCI will progress to dementia, Levin said the evidence shows that is far from certain.

“The numbers are less scary than many people believe,” she notes. “The majority of people with MCI will not progress to dementia and loss of independence, even after 10 years. Some patients with MCI will actually have improved cognition after a year or two, if their cognitive test scores were brought down by an acute illness that gets addressed.”

In fact, older adults with MCI are 12 times more likely to die from cardiovascular disease than dementia. That’s why it’s essential to fight risk factors.