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.
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.
- 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.