Q: I realize that I sometimes have difficulty connecting a name and a face. I presume that this is mild cognitive impairment.
On researching the topic online, I find a variety of suggestions for alleviating it. These include supplements (lipoic acid, vitamin E, omega 3s, curcumin), food choices (fish, vegetables, black and green teas), aerobic exercise, yoga, and meditation.
Do these actually help with mild cognitive impairment? What’s been proven to work?
A: It’s common for older adults to feel they’re having trouble with certain memory or thinking tasks as they get older.
I can’t say whether it’s mild cognitive impairment (MCI) in your particular case. But we can review what is known about stopping or slowing cognitive changes in people diagnosed with MCI.
First, let’s start by reviewing what MCI is, and how it’s diagnosed. Then I’ll share some information on the approaches you are asking about, as well as other approaches for treating MCI.
What is Mild Cognitive Impairment?
Mild cognitive impairment (MCI) means having cognitive abilities (memory and thinking skills) that have become worse than “normal” for your age. However, the impairments can’t be bad enough to meet the criteria for dementia.
If you’re concerned about your memory, it’s important that you not assume it’s MCI. Instead, you’ll want to have your thinking skills assessed by a clinician. This is how you can find out if your difficulties fall within the range of “normal age-related changes” versus being worse than normal, which is a criterion for having MCI.
Studies find that many older people feel that their memory or thinking is getting worse. However, this doesn’t necessarily mean they have MCI.
This is because declines in certain types of memory and thinking skills are now known to be part of normal “cognitive aging.”
In fact, difficulty connecting “names and faces” is a common complaint among normal older adults. It’s probably due to the known slowing in brain processing speed that occurs as people age.
As of 2013, MCI is also called “mild neurocognitive disorder” whereas dementia has been renamed “major neurocognitive disorder.” While you might not need to know these more technical terms, it may save some confusion if you are reading about newer research. (Most practicing doctors still use the older terms however.)
Experts believe that some people with MCI are essentially in the very earliest stage of a disease such as Alzheimer’s or another type of dementia. Studies suggest that over 5 years, 30-40% of people with MCI will progress to dementia.
However, that’s only 30-40% of people. So not all MCI is early dementia. Some people with MCI never seem to get much worse, and some even seem to get better.
How is mild cognitive impairment diagnosed?
MCI is diagnosed through a clinical assessment done by a qualified doctor or other healthcare professional.
A clinical assessment should usually include:
- Interviewing the patient regarding his concerns, and inquiring about difficulties managing life tasks
- Assessing whether family members and other observers have noticed anything concerning
- Evaluating cognitive abilities using a short office-based test, such as the Montreal Cognitive Assessment
- Checking prescribed and over-the-counter medications, to see if any are known to make thinking worse (see 4 Types of Brain-Slowing Medication to Avoid if You’re Worried About Memory)
- Evaluating for medical conditions, including mental health conditions and sleep disorders, that can worsen thinking or can mimic early dementia
Laboratory work is often necessary, to check for problems such as thyroid disorders, vitamin B12 deficiency, and electrolyte imbalances.
After this initial assessment, a person might be referred for additional neuropsychological testing. These tests provide a more in-depth assessment of specific memory and thinking skills. They can help further categorize MCI as “amnestic” (meaning the problems are mainly with memory) versus non-amnestic.
Ultimately, the process of diagnosing MCI is similar to diagnosing dementia: it requires documenting concerns and difficulties, objectively assessing cognitive abilities, and ruling out other medical problems (including medication side-effects and delirium) that might be interfering with brain function.
But in MCI, the cognitive impairments should not be severe enough to interfere with daily life.
For more on evaluating the complaint of cognitive impairment in older adults, see here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
What are proven ways to treat mild cognitive impairment?
In many clinical trials, the goal in “treating” mild cognitive impairment has been to reduce the risk of progression to Alzheimer’s or another dementia.
Unfortunately, almost nothing has been proven to work, although some approaches are promising.
In particular, no medications are FDA-approved for the treatment of MCI, as none have been shown to prevent progression to dementia.
If you’d like more information, the Canadian Medical Association Journal published: “Treatment for mild cognitive impairment: a systematic review and meta-analysis” in 2015.
In January of 2018, the American Academy of Neurology issued their “Practice guideline update summary: Mild cognitive impairment. They suggest that clinicians recommend regular exercise and say they “may recommend cognitive training.” They make a stronger recommendation for stopping medications that interfere with cognition, and they reiterate that “no high-quality evidence exists to support pharmacologic treatments for MCI.”
Exercise for MCI
The approach that seems most promising is exercise, although it’s unclear which exercise is best. One randomized study showed an improvement in patients doing different exercises, another indicated that resistance training helped.
A sensible approach is to include all important types of exercise. That is: aerobic, resistance, balance, and flexibility exercises.
Although it may not be clear which one is best for MCI, all four are necessary to maintain overall health and mobility in older adults.
You can learn more about the four types of exercise at the National Institute on Aging’s site Go4Life.
Dietary approaches for MCI
There is research to suggest that diet plays a role in dementia. However, it’s not yet clear what particular diet will prevent MCI progressing.
I personally agree with the common-sense approach that a diet that is good for overall health is likely to be good for brain health.
If you’d like to read about nutrition studies in detail, I recommend Dr. Michael Greger’s book “How Not to Die.” It covers relevant nutrition research on brain health and many other aspects of health.
One of my favorite clinical nutrition trials is titled the “Cocoa, Cognition, and Aging (CoCoA) Study.” In 2012 the researchers published the results of a study in which they found that giving people with MCI a daily cocoa drink led to improved cognitive function and insulin metabolism eight weeks later.
Now, we still don’t know if daily cocoa would change the likelihood of having dementia a few years later. But it’s a promising result, and you can learn about more such promising foods in Dr. Greger’s book.
Supplements for MCI
Some researchers found that a vitamin B supplement (a combination of folic acid, vitamin B6, and vitamin B12) reduces cognitive decline in MCI. But this may only be in people who have high homocysteine levels.
(Homocysteine is a common amino acid – one of the building blocks that make up proteins – found in the blood. High levels have been associated with low intake of folate and vitamin B12.)
A large trial published in 2005 found that vitamin E had no effect on the progression of MCI.
A variety of other anti-oxidants have been studied, but so far nothing seems to be definitely beneficial. (A review can be found here.)
Medications for MCI
There are currently no medications that have FDA approval for the treatment of MCI.
Some medications have been trialed but have not been shown to prevent the progression of MCI. These include medications such as donepezil, galantamine, and rivastigmine (brand names Aricept, Razadyne, and Exelon, respectively).
One 2012 review published by the respected Cochrane Library concluded that these types of medicines ” should not be recommended for mild cognitive impairment.”
However, many doctors prescribe these medications to people with MCI, especially if they have amnestic MCI. In theory, this might help mitigate some of the memory symptoms.
But if a person with MCI doesn’t notice some improvement after starting the medication, they should not be surprised. And they should not feel obligated to continue the medication.
Yoga and meditation for MCI
Stress tends to worsen brain function. So it’s possible that stress-reducing activities like yoga or meditation might help in MCI.
Yoga has mainly been studied in older adults with “normal” cognition. Results suggest yoga can benefit cognition but further research is recommended.
Meditation may improve MCI. A small study found that mindfulness-based stress reduction was associated with encouraging brain changes on functional MRI scans.
Brain training for MCI
People sometimes wonder if “brain training” can keep MCI from progressing to dementia. So far this is unknown.
Much of the brain training research has studied whether the intervention improves memory and cognitive function in the short-term. A 2016 review found that brain training seems to improve certain cognitive abilities in the short-term.
My main recommendations for managing MCI
The bottom line is that no treatment has been convincingly proven to improve long-term outcomes in MCI. So I think it’s best to focus on general things that promote brain health.
That is:
- Avoid brain-slowing medications
- Avoid chronic sleep-deprivation
- Avoid delirium
- Pursue positive social activities, purposeful activities, and activities that “nourish the soul”
- Find constructive ways to manage chronic stress (consider meditation or yoga)
- Seek treatment if you have signs of depression or chronic anxiety
- Stay physically active and exercise regularly
- Address risk factors for cardiovascular disease
- Consider the Mediterranean diet (or other healthy eating approaches)
For more information on these common-sense brain health approaches (which are generally good for physical health and healthy aging), see “How to Promote Brain Health: The Healthy Aging Checklist, Part 1.”
If you’re worried you might have MCI
You can see that this is a complex area. Mild cognitive impairment is not as simple to diagnose as diabetes, nor is it as easy to treat.
However, it’s just as important to see a doctor. So don’t make assumptions if you notice changes in memory or thinking. That’s a huge risk.
Instead, if you have signs of MCI, make sure you get evaluated by a professional. See your doctor.
You can promote brain health (start by reviewing the approaches I recommend in the Healthy Aging Checklist Part 1.)
They can check what other factors may be affecting your memory and thinking. They can support you and help you find answers to your questions. They can help you manage your symptoms and provide peace of mind.
So don’t sit, and wait, and worry.
Pick up the phone and make an appointment. Make sure they check for medication side-effects and other medical problems that can worsen thinking. And make sure they know if you’ve been having trouble with finances, driving, or other life tasks.
And then if you are diagnosed with MCI, you can come back to this article for a refresher on what approaches are most promising, when it comes to treatment.
How do you handle a spouse who you suspect of having memory/behavorial problems? Does one “tattle” to your spouse’s physician, or simply arrange to meet with someone who can advise as to what steps should be taken?
Good question, and one that comes up quite a lot.
Generally yes, you absolutely want to bring the problems to the attention of the person’s physician. The trick is to find a way to do so that doesn’t feel like “tattling” to you and your spouse. Although sometimes people find they have no choice but to “go behind someone’s back,” this should be the option of last resort. Ideally, your spouse will know you are contacting the doctor with your concerns, and won’t explictly object.
To achieve this, try bringing up your concerns and your desire to notify the doctor, using as many “I” statements as possible:
“I’ve noticed you seem to be having trouble with XX”
“I would feel better if we brought it to your doctor’s attention”
It also often helps mention that older adults often experience medication side-effects or medical problems that affect memory and thinking. So you can frame the suggestion to approach the doctor as a way to look for things to treat so that the person can have the best brain health possible.
If push comes to shove, you can send a letter detailing your concerns and observations to the doctor, whether or not your spouse agrees. The doctor cannot reveal your spouse’s personal health info to you, but nothing prevents you from sharing health info with the doctor. The downside is that taking action unilaterally often upsets the spouse. So it’s much better to find a diplomatic way to get your spouse to agree — or at least not expressly forbid you to contact the doctor.
If you want help having a diplomatic conversation with your spouse, a geriatric care manager (also known as an Aging Life Care professional) can often help. Look for one with experience in family therapy or otherwise moderating difficult conversations.
Last but not least, you can find suggestions on evaluating memory in reluctant older people in these two podcast episodes:
Solving Hard Problems in Helping Aging Parents
Helping Reluctant Parents Address Memory Concerns
Good luck!
My mother has had some signs of MCI for the last few years. She has gone to her PCP and he does not seem to think it is anything to worry about. Just recently things have become worse. There is a lot going on in her life right now… as she is in transition to move to a continuing care community, sell her house, and we found that she has been scammed (severely) by phone and by mail. We are moving her closer to her community but she cannot move in until December. Would her more rapid progression be, at least partially, due to the changes in her life?
Trying to find a local geriatric physician, what should we be looking for?
Thank you for your time and the information you share.
Yikes, I’m sorry to hear she’s been scammed. Good that you are helping her take steps to be better protected.
Yes, any type of life stress can make a person’s thinking get worse. That said, if her symptoms are accelerating then I would also recommend you bring this up to her doctor and ask if she can be checked for any of the common medical problems that make thinking worse. These include problems like medication side-effects, electrolyte imbalances, and basically most of the things we check for when someone first reports memory or thinking problems. I assume she was evaluated a few years ago and she didn’t have any such problems at the time, but it’s still important to check again and make sure she isn’t being affected now.
I have tips on finding a geriatrician here: How to Find a Medication Review. Good luck!
Hi Leslie, I recently came across your site while doing some research on a client. This is amazing work here. Great job.
Hi Leslie, my mother aged 76 was diagnosed with MCI October 2016. We were pleased with this diagnosis as she has 3 sisters with Alzheimer’s and we suspected she did also. For the following 6 months she was mainly fine just getting muddled when getting a bit stressed. We had a follow up appointment and because she had not got any worse, was discharged from the memory clinic. Since then my father has been unwell, a hospital visit of nearly 3 weeks in which time my mother had to come and stay with me and even though he is home, he is still in bad shape and causing us all worry, especially my mother. So for the past 6 weeks she has been very muddled, not knowing people she would usually know, sometimes not knowing familiar places. Not really able to make a meal, very forgetful. Anxious about appointments, gets mixed up on timescales. I wonder if her condition could have moved on and we should get her retested or if the stress of my father has made her much worse?
I would say yes and yes. Yes, it’s possible that her condition has progressed, so that even when she’s at her best, she might now meet criteria for a dementia such as Alzheimer’s.
And, in all likelihood, the stress of your father’s illness is making her worse than she’d be otherwise.
In terms of retesting: I think what is most useful in these situations is to retest for non-Alzheimer’s causes of getting cognitively worse. These include medication side-effects, electrolyte imbalances, and a few other conditions that could have come on during the past few months.
Otherwise, ask yourself how will the retesting help you better help your mom? Will it help your family make decisions about driving, or housing, or how to provide practical support to your mom, or anything else? If not, just take each week as it comes and see if your mom gets better as your dad’s situation stabilizes. Good luck!
Thank you for your helpful columns! The thoroughness is superb!
My father was diagnosed with MCI a few years back and did not tolerate Aricept or Namenda. He has been exercising regularly and keeping a vegan diet, until recently when his doctor, who is into homeopathic treatments, encouraged him to gradually switch over to a ketogenic diet and follow the Breseden Protocol (https://www.drbredesen.com/thebredesenprotocol). Have you heard of this treatment approach? Could you please share your thoughts about it. It is very demanding and I am worried that all of the components will increase his stress levels, but he is willing to try it.
Thanks in advance!
Yes, I have heard of Dr. Bredesen’s work. It is interesting and promising, but so far the published research seems preliminary in that he has only reported on small groups of participants. They were also mostly younger than your father. The participants and results are described here:
Reversal of cognitive decline in Alzheimer’s disease (2016)
The protocol (the 2014 version) is described in Table 1 here:
Reversal of cognitive decline: A novel therapeutic program
For now, I think it’s plausible that the Bredesen protocol can help some people with cognitive impairment and presumably further research will shed light on which people are most likely to benefit.
Your father could give it a try for a few months and see how it goes. I would recommend getting some cognitive testing and other objective data before starting, that way you will have a benchmark to compare to later. His usual doctor might be able to do a MOCA test on him (Montreal Cognitive Assessment Test), this is a test that takes 15-20 minutes and can be done in a primary care setting. (You could also request more extensive neuropsych testing, but that might be harder to arrange and it will certainly be more tiring for your father.)
Alternatively, he could ask to be tested for some of the issues that the Bredesen protocol addresses, such as insulin resistance. The idea would be to see if it’s possible to use the protocol to identify some particular issues that might be especially relevant to him.
FWIW, ketogenic diets have been studied in rats and in humans with epilepsy, but I have not been able to find published research on their long-term effect for mild cognitive impairment. Future research may or may not confirm their effectiveness.
I do think it’s important to exercise, to minimize stress, to sleep well, and also to minimize inflammation in the body and insulin resistance. A diet with lots of vegetables, fruits, nuts, spices, and fiber is also very promising. (Not all vegan diets achieve this.)
Good luck, let us know how it goes!
My mother broke her hip and was diagnosed with mild dementia in the hospital. Since then she has gotten worse with her memory and has turned on me and accused me of all sorts of things. I have been taking her to all her appointments and she has always allowed me to know all her financial dealings until now. She has become paranoid more often and shuffles papers continually and doesn’t understand what she’s looking at. Her own financial advisors say she should be deemed incapable. I am in the trust and have been assigned her P.O.A . My mother’s primary Doctor is not helping . She gave her a cognitive test that was a score of 17. How do I proceed with this
It’s a little tricky to diagnose people with dementia when they are hospitalized, because often they are experiencing some delirium, which makes their thinking worse than usual (for more, see Hospital Delirium: What to know & do).
You don’t say how long it’s been since her hospitalization, but if it was recent, it’s possible that she still has some residual delirium, and that she might get better if that resolves.
You also don’t say what cognitive test was done, but both the Mini-Mental state exam (MMSE) and the Montreal Cognitive Assessment (MOCA) are scored out of 30, so 17/30 is pretty impaired. Even if she improves a bit, at her best thinking, she’ll probably still qualify as having mild dementia.
In terms of how you proceed, I’m not sure what you mean. Legally and financially? Or how to cope with her paranoia? You will probably need to sort out a variety of issues on both fronts. It’s very lucky that you have power of attorney per the trust, but of course implementing financial oversight still can take a lot of work, especially if the person with dementia has become paranoid or is resisting.
What to do really depends on what specific challenges you are encountering. Generally, families find it easier to modify what their relative does rather than what banks do, e.g. hide/remove the checkbook and ATM card rather than get the bank to stop letting her withdraw money.
But of course, none of this is easy, especially if a person has become paranoid or otherwise difficult. I would certainly recommend getting more support and information from books and support groups. I like Surviving Alzheimer’s, by Paula Spencer Scott, and then there’s a very active online caregiver support group at AgingCare.com.
You also might find these articles helpful:
6 Causes of Paranoia in Aging & What to Do
Incompetence & Losing Capacity: Answers to 7 FAQs
Good luck, you are always welcome to post more questions here, as specific quandries come up.
I had MRI scan it came back with two small alchemica and the nurolugist has said no further action .and discharged me .i am now worried reading comments from people on here I am fit just arthritis and mild fibromyalgia can you advise me what to do next please
I’m not sure what you mean by an MRI with “two small alchemica,” but even if I knew, I don’t know that I have more to add beyond my suggestions in the section “My main recommendations for managing MCI” above.
If you are prone to worry, then you might especially benefit from taking the time to enroll cognitive-behavioral therapy or some type of mindfulness stress reduction course, to help you better hope with the ongoing uncertainty. People who are worrying a lot often have difficulty sleeping and higher stress levels, which tends to make thinking (and pain) worse.
You may also find it helpful to join a local or online support group, for people with MCI or whatever diagnosis you currently have. Good luck!
Thank you so much for this explanation. I have been having some mental troubles recently, and i decided to do some research for myself to get a better understanding of what’s out there when it comes to brain conditions. Thanks for mentioning that aging is a factor, and not a thing to worry about.
Dr. Kernisan, I am currently seeking diagnosis and participating in a clinical trial for dementia. I took gen test I am psen2 complete deletion. I am 54 and my mother had dementia at 41, Is it possible that if I have MCI at this point with effortful lifestyle changes—mental stimulation, Medit diet, exercise I can halt and/or reverse prog to Dementia. In 2017 my MRI was normal; I repeated this year and I am awaiting results. I also suspect I have beg of Lewy Body and not Alzheimers. My mother had more of symptoms of Lewy Body but uit was not diagnosed in 1970s and early 1980s when she progressed.
Well, anything is possible and some preliminary research does suggest that intensive lifestyle changes might influence progression to dementia.
In a comment above I discuss Dr. Dale Bredesen’s research, see here. It is promising, especially when it comes to people who are younger, as you are. Good luck!
I met Dr. Dale Bredesen last night and was hugely impressed with him and his rigorous research and resulting protocol. My husband and I were exposed to his book, “The End of Alzheimer’s” through our doctor, who has since become a Bredesen-trained practitioner. I hope you are aware of the book and the fact that by now there are at least hundreds of people who have reversed fairly significant MCI symptoms, many in their 70s. Last night Dr. Bredesen reminded us that there are three factors determining the success of his rigorous protocol for patients who choose to participate: 1) The type of Alzheimer’s the person is developing (he has a identified three), 2) How thoroughly they are following his program, and 3) Not surprisingly, how far their disease has progressed. Although my husband has been on the program fully for only about four months, he seems to be improving, and certainly not getting any worse. I thank you for your valuable work and hope you will consider reading Dr. Bredesen‘s book and suggesting a high-fat ketogenic diet to your brain impaired readers. It seems to us that it is this anti-inflammatory, ketone-producing food plan which , along with the exercise, sleep and other practices you recommend, may make the critical difference.
I have already commented on Dr. Bredesen’s work in a previous comment (see here) and yes, I have read his book. When I have time, I plan to do some more research regarding his recommendations. I would especially like to interview some of the other neurologists researching Alzheimer’s, to get their take on his suggestions.
I do think his findings are promising and agree that making significant diet interventions may be worth a try. Many of the other lifestyle changes recommended in his protocol (exercise, meditation, sleep) are also generally beneficial for the brain and so it makes sense to adopt them as well.
I came to this site looking for info on dealing with a spouses MCI and the psychotropic meds she is on. There is a lot of info out there on the web but your site is like an oasis full of clear insight, knowledge and compassion. Thank you for your contribution to helping others and to making the world a better place.
Thank you, I’m so glad you find the site helpful. Good luck helping your spouse.
Please suggest how to find a knowledgeable compassionate geriatrics doctor like you in San Diego who would accept Medicare. My cardiologist would not approve of a high fat diet. I have calcified veins.
My suggestions on finding geriatric care are here:
How to find geriatric care — or a medication review — near you
Good luck!
Hello Doctor Kernisan. My wife, age 62, has had memory issues for about a year now. They can be long term, or short term, depending on the day. She has seen her primary doctors, as well as a Neurologist and a Neuropsychologist. She has had labs, CT Scan, XRays, etc. all of which have shown nothing.
They told us to reevaluate her meds, which we have done. She wasn’t on any of the meds that you’ve mentioned, although we have modified some dosages, and discontinued one. Her Neuropsychologist said he “may” have some MCI, but nothing conclusive.
She is under stress due to our daughter and 2 year old granddaughter, that she is forced to watch 40 hours per week, and I think this is contributing to her issues, but my wife feels she has no choices in this situation.
We don’t know where to turn to anymore. Due you have any suggestions? Thank you for your time, and excellent, informative column.
Sorry to hear of your wife’s memory problems. If she has had a reasonable evaluation, then the main things to do are try to optimize lifestyle factors that promote brain health, and otherwise, cross your fingers and wait to see how things evolve.
Exercise, good sleep, reducing stress, and probably some kind of mindfulness/meditative practice all seem to help. Some people believe that significantly changing the diet can also make a difference; I suspect it depends on whether a person is prone to experience inflammation or other health changes due to their diet. The neurologist Dale Bredesen describes an extremely intensive lifestyle change program in his book the End of Alzheimer’s. My neurology colleagues in academia tell me it has not been adequately tested or proven, but it might give you some ideas on lifestyle changes to consider. Good luck!
I sustained a bilateral basilar skull fracture 40 years old and was in a coma for one week. Would you comment please how TBI affects the risk of dementia? Thank you.
The relationship between traumatic brain injury (TBI) and dementia is an area of active research. A study of TBI in older adults found that it was associated with Parkinson’s disease and Lewy Body accumulations, but not Alzheimer’s pathology.
Association between Traumatic Brain Injury and Late Life Neurodegenerative Conditions and Neuropathological Findings
I think it’s unclear what the risk would be for someone with your situation, having a TBI at age 40.
I would encourage you to focus on dementia risk factors that you can actually control now. Good luck!