Recognizing the Signs of Mild Cognitive Impairment Due to Alzheimer’s Disease
MCI can be an early stage of Alzheimer’s disease, and the sooner it is diagnosed, the better the outcome. So it’s important to recognize the differences between normal aging and more serious cognitive decline.
Understanding Mild Cognitive Impairment Symptoms
Tip-of-the-tongue moments are normal with aging. But when other signs of cognitive decline occur too, something more serious may be going on.
Almost everyone can relate to misplacing their car keys or forgetting the name of an actor in their favorite movie. It’s a type of memory lapse that can become even more common with age.
“As we get older, our bodies and our brains age,” says Monica Moreno, senior director of care and support at the Alzheimer’s Association. That’s why it can be easy to regard problems with memory or reasoning as a normal part of aging. “But there are some symptoms or warning signs that may indicate something more serious is going on,” she says.
MCI and Alzheimer’s: What’s Happening in the Brain
Mild cognitive impairment is characterized by a wearing down of the myelin sheath that surrounds neurons, which are nerve cells responsible for sending and receiving messages between the brain and other areas of the body. As the protective myelin erodes, communication between neurons slows down, which can interfere with the ability to retrieve memories and information. That’s typically the reason for those tip-of-the-tongue moments that are familiar to many people as they head toward their 60s and beyond.
MCI can remain stable or — for 10 to 15 percent of people diagnosed with the condition — progress to Alzheimer’s disease or another type of dementia, according to the Alzheimer’s Association. In this case, the damage to the neurons is due to abnormalities in certain naturally occurring proteins in the brain called amyloid and tau. Neurons eventually stop working altogether, and the connections between them break down.
In the early stages of both MCI and Alzheimer’s, the damaged neurons are usually located in the hippocampus, which is the area of the brain involved in memory storage. Later on, the neurons elsewhere in the cortex — areas responsible for language, social behavior, visual spatial ability, math, and reasoning — can also be affected.
Early Signs of MCI Due to Alzheimer’s
People with Alzheimer’s disease will often experience more severe memory loss than people who are aging normally. This degree of memory loss leaves them “amnesic” — unable to remember new information. They typically repeat, ask questions over and over, and rapidly forget what was said between questions.
Other symptoms are likely to set in also. These include difficulty carrying on a conversation, using the wrong name for an object, being unsure, and not understanding problems, situations, and explanations easily. “When we test [a person for Alzheimer’s disease], we test whether they have memory impairment plus impairment in another domain,” says Victoria Leavitt, PhD, a clinical neuropsychologist at Columbia University in New York City.
Among the signs of Alzheimer’s are:
Memory Loss That Interferes With Normal Functioning
One of the most common (and earliest) signs of Alzheimer’s disease is an inability to remember information, particularly new information. Over time, this memory loss can start to take a toll on daily life. A person in the early stages of Alzheimer’s may forget about appointments, medications, how to get to a familiar location, or how to pay bills. They may forget what they need at home and buy the wrong things. They may make errors driving or get lost.
Difficulty Doing Familiar Tasks
When Moreno asks people with Alzheimer’s what prompted them to see a doctor, they often say they’ve been having trouble doing activities that they did their whole life. “Tasks that had been so normal and easy for them were now becoming more and more difficult,” she says.
For example, “I met a woman who was a vice president of a bank, and one day she was trying to help her grandsons with their homework and she couldn’t do a simple math problem,” she says. “Then there was an award-winning chef who suddenly forgot how to make an omelet one morning.” In each case, tasks that had been easy for that particular person suddenly became impossible.
“If there’s something that you’ve done your whole life, and now all of a sudden you’re being challenged with doing it, that can be an indication that something more serious is going on,” says Moreno.
Trouble Speaking or Finding the Right Words
Dr. Leavitt says that along with memory loss, people with MCI typically have trouble with language. “It comes across as, ‘I can’t get the words out,’” she explains. “Or, ‘Her name is on the tip of my tongue.’”
“It’s something that’s very common, but [in people with Alzheimer’s], it’s more severe,” she says.
People with MCI due to Alzheimer’s may also have trouble keeping up a conversation. They may stop in the middle of a sentence and lose their train of thought, for example, or repeat themselves. They can also have trouble retrieving words from their brain’s storehouse of information, which is known as “lexical access.”
“Think of your brain as a big warehouse,” Leavitt explains. “You’ve got all these little forklifts, and you send them off to aisle 9, row 47. That requires coordination among areas of your brain to go to the right place, grab the information, and bring it out. … When it falls apart a little bit, that’s normal, healthy aging. But when that starts to fall apart a lot, that tends to be a signifier of Alzheimer’s.”
Other signs of MCI or Alzheimer’s include difficulty keeping track of time and dates, trouble judging distances, withdrawal from family and friends, and poor decision-making (such as overspending). All of these can make daily life challenging and even unsafe.
When to See a Doctor
Moreno encourages people to see a doctor if they (or a loved one) notice even one of the symptoms of MCI or Alzheimer’s. “You shouldn’t wait to experience all the signs,” she says.
A general doctor, neurologist, geriatrician, or psychiatrist can perform tests to evaluate cognitive functioning. The ones that are most often used include:
The Montreal Cognitive Assessment, which involves memorizing a short list of words, naming certain objects, and copying shapes.
Mini–Mental State Examination, which requires counting backward, identifying objects, and recalling other facts, such as the date.
Mini-Cog screening, which involves memorizing and recalling words and drawing a picture of a clock with its hands pointing to a specific time.
A neurologist can also order bloodwork and brain scans, such as a CT scan or MRI, to evaluate the structure of the brain and find possible contributing causes. A PET scan of the brain can reveal the presence of amyloid. And a spinal tap, in which fluid is drawn from the spinal cord, can reveal the presence of amyloid and tau.
It’s important to get a diagnosis as soon as possible, because the medications that slow the progression of the disease work best when used early. It’s never too early to get help for distressing symptoms of memory loss, functional problems, and neuropsychiatric problems, such as anxiety, depression, apathy, and irritability. By the same token, don’t avoid diagnosis and treatment because you think it’s too late.
“It can be hard to face the reality of decline that [you or] a loved one is experiencing,” says Leavitt. But, she adds, “You have to put safety above everything else.”
EDITORIAL SOURCES
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David Weisman, MD, is the director of the Clinical Trial Center at Abington Neurological Associates in Pennsylvania, where he has conducted numerous clinical trials into mild cognitive impairment and Alzheimer’s disease to develop disease-modifying drugs.
Dr. Weisman has dedicated his research career toward advancing new therapies for Alzheimer’s disease, focusing on clinical trials for the prevention and treatment of Alzheimer’s disease, mild cognitive impairment, and other dementias, and he devotes his clinical practice to memory and cognitive problems.
He received a bachelor's degree in philosophy from Franklin and Marshall College, then an MD from Penn State College of Medicine. After an internship at St. Mary’s Hospital in San Francisco, he completed his neurology residency at Yale, where he served as chief resident. He then went to the University California in San Diego for fellowship training in Alzheimer’s disease and other dementias.
Weisman has published papers and studies in journals such as Neurology, JAMA Neurology, Stroke, and The New England Journal of Medicine, among others.
Maria Masters is a contributing editor and writer for Everyday Health and What to Expect, and she has held positions at Men's Health and Family Circle. Her work has appeared in Health, on Prevention.com, on MensJournal.com, and in HGTV Magazine, among numerous other print and digital publications.
