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Mild Cognitive Impairment In Older Adults Can Improve

As we get older, we may notice that we're forgetting things, or we're having trouble remembering names, or... And we wonder if we're starting to "lose our mind" and developing dementia.

A recent study has good news - even in persons labeled as having Mild Cognitive Impairment (MCI), 2 1/2 years later about half had improved and no longer fit the criteria of mild cognitive impairment. Back to normal! (Other studies have similar results.)

The big question is why do so many improve, and why do others get worse?

This study conducted by Columbia University researchers was part of a long-term study looking at aging in older adults (65 years old or older) and living in New York City (thus the study was "community based"). All 2903 participants (white, black, and Hispanic) did not have Mild Cognitive Impairment or dementia at the start of the study (the baseline), were followed for 6 years, and evaluated (including physical and neurological tests) every 18 to 24 months.

After an average 2.4 years follow-up after MCI diagnosis: 12.9% of individuals progressed to dementia, 9.6% declined in functioning (but did not meet the criteria for dementia), 29.6% continued to meet MCI criteria, and 47.9% no longer met MCI criteria. This last group was now "cognitively normal". (!!)

The  researchers found that the presence of the APOE4 gene (which increases the risk of Alzheimer's disease) and having more medical problems ("medical burden") increased the risk of MCI. On the other hand, more years of education, more leisure activities (e.g., reading, socializing, taking walks), and higher income decreased the risk of developing MCI. But MCI across several domains, being a carrier of the APOE4 gene, depressive symptoms, and antidepressant use increased the risk of progression to dementia

Bottom line: Older adults should try to be active, get exercise (walking counts!), have a healthy lifestyle, socialize, and be busy - it's good for mental health. Studies also find participation in arts, crafts, and using computers all lower the risk of older adults developing MCI.

From Medical Xpress: 'Mild cognitive impairment' in older age often disappears, study finds

A diagnosis of mild cognitive impairment (MCI) might worry an older adult, who could see it as a stepping stone to dementia. But a new study suggests one does not necessarily lead to the other. 

In fact, nearly half of seniors tracked in the study—all of who had been diagnosed with issues in memory and thinking and received an MCI diagnosis—no longer had the condition a few years later. The study was conducted to help better understand what factors might be important to a person's risk for dementia.

She said the study was conducted among a diverse group of Americans. "Most prior MCI studies are conducted among only non-Hispanic white older adults who seek help from a doctor who specializes in memory disorders," Manly explained.

The findings highlight that people who have MCI are a varied group, she said. They won't all develop dementia in the short term, which suggests that MCI status should be viewed as a "higher risk classification," and not as an early stage of dementia, Manly said.

Interestingly, the predictors of MCI are not necessarily the same factors that predict progression of MCI to dementia, she added.

For the study, the researchers followed just over 2,900 study participants, average age mid-70s, for about six years.

During the research period, 752 participants were diagnosed with MCI. Those diagnoses happened when the participants reported problems with memory or thinking and a test showed cognitive impairment. They were still able to maintain daily activities and had problems with fewer than three activities, such as shopping or handling medications, according to the study.

Of those with MCI, 480 did follow-up assessments. Two years later, 13% of those with MCI had dementia. Another 30% still had MCI but had not developed dementia. About 10% had declines in mental functioning, but still did not meet the criteria for MCI or dementia.

But nearly half—48%—of those who had previously been diagnosed with MCI were "cognitively normal" on a follow-up visit an average of 2.4 years later. They may have met one or two of the three criteria for MCI initially.

Among the modifiable risks that predicted a lower risk of developing MCI, researchers found that having more years of education and taking part in more leisure activities like reading, visiting a friend or going for a walk could make a difference. So, too, could a higher income. Specifically, those who had more education or participated in more leisure activities were 5% less likely to develop MCI.

Predictors that increased the risk of someone with MCI developing dementia included the use of antidepressants, having symptoms of depression, having the particular gene that increases Alzheimer's risk and having MCI that affects several aspects of thinking skills, including memory, language and spatial skills.

About 18% of those who used antidepressants developed dementia, compared to 7% who continued to have MCI and 6% of those who no longer met the criteria for MCI, the findings showed.

While mild cognitive impairment has often been thought of as a precursor to dementia and Alzheimer's disease, MCI is really a mixed group with cases that will diverge along different paths, said Dr. Zaldy Tan, director of the Memory and Aging Program for Cedars-Sinai in Los Angeles. Tan was not involved in the study.

"I think it just confirms that people with mild cognitive impairment are a heterogeneous group, that some people are in fact on the Alzheimer's disease or dementia path, and some people are having mild cognitive impairment because of other things that are potentially reversible like depression, poor sleep, for example having obstructive sleep apnea," Tan said. "Some of these things can interfere with memory, and someone can have a subjective complaint of a memory problem but may not necessarily have the pathology for dementia."

Evidence suggests that a healthy lifestyle, including regular physical activity, good sleep, controlling heart risk factors, reducing stress and remaining cognitively and socially engaged are all beneficial for overall brain health, Tan said, but that does not mean they will prevent someone with MCI from developing dementia.

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