Mild cognitive impairment: Most people are unaware they have condition

Evan Walker
Evan Walker TheMediTary.Com |
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Experts say friends and family are sometimes the first to notice mild cognitive impairment. Johner Images/Getty Images
  • Mild forgetfulness is largely seen by many people as well as doctors as part of normal aging.
  • However, experts say mild forgetfulness can also be symptomatic of mild cognitive impairment, which can be an early sign of Alzheimer’s disease.
  • They say people should specifically ask doctors about excessive forgetfulness, otherwise doctors may just minimize the problem.

Small, everyday forgetfulness – not remembering why you walked into a room or not being able to find your phone – may seem to many like the normal process of aging.

However, these lapses can sometimes be symptomatic of mild cognitive impairment (MCI), which itself can be an early sign of Alzheimer’s disease.

Since it’s considered normal by many – including some doctors – people who have MCI don’t always know it and miss out on taking preventative measures or getting treated, according to two new studies published in parallel by researchers at the USC Dornsife College of Letters, Arts and Sciences in Los Angeles.

In one study, researchers looked at data from 40 million Medicare beneficiaries, 65 years and older, and compared the proportion diagnosed with MCI with the rate expected in this age group. They reported that fewer than 8% of expected cases were actually diagnosed.

That means that of the 8 million individuals predicted to have MCI based on their demographic profile – which includes age and gender – more than 7 million went undiagnosed.

“This study is meant to raise awareness of the problem,” said Soeren Mattke, director of the Brain Health Observatory at USC Dornsife’s Center for Economic and Social Research, which led the investigations, in a statement.

“We want to say ‘Pay attention to early changes in cognition and tell your doctor about them. Ask for an evaluation.’ We want to reach physicians to say, ‘There’s a measurable difference between aging and pathologic cognitive decline and detecting the latter early might identify those patients who would benefit from recently approved Alzheimer’s treatments,” he added.

In the second study, researchers reported that 99% of 200,000 primary care clinicians under-diagnosed MCI.

“There’s really just a tiny fraction of physicians in a position to diagnose MCI who would find these cases early enough for maximum therapeutic potential,” Mattke said.

The team said, by definition, MCI doesn’t cause disability, whereas dementia is a disabling condition.

MCI’s challenges to everyday functioning tends to be more sporadic, said Soo Borson, a clinical professor of family medicine at Keck School of Medicine of USC and co-lead of the BOLD Center on Early Detection of Dementia, in a statement.

Borson, who was not involved in the studies, said forgetfulness is the most familiar form of MCI. Another is an executive form, which mainly affects efficiency in getting things done and difficulty with tasks that used to be easier, such as paying bills. There’s also a behavioral form, in which mild changes in personality may predominate. The various forms often coexist.

The researchers said it’s important to understand MCI is a level of cognitive functioning and not a specific disease state. Recent advances in the treatment of the most common cause of MCI — Alzheimer’s disease — lends new urgency to improving detection of MCI, they said

Researchers said there are several reasons MCI might be so widely underdiagnosed in the United States. A person may not be aware of or bring up their concern. In addition, a physician might not notice subtle signs of difficulty. Or, a clinician might notice but not correctly enter the diagnostic code in a patient’s medical record.

Researchers also said time may not be set aside during a clinical visit to discuss or assess brain Health unless the visit was planned to include it.

Mattke said risk-based MCI detection, which focuses attention on people at greater risk, would help identify more cases because time and resources could be focused on those people. Digital tests administered before a medical visit could also aid in detection efforts.

Early treatment is vital because the brain is limited in its ability to recover. Lost brain cells don’t grow back and damage can’t be repaired, researchers noted.

“For MCI caused by Alzheimer’s disease, the earlier you treat the better your outcomes,” Mattke said. “This means even though the disease may be slowly progressing, every day counts.”

Dr. David Merrill, a geriatric psychiatrist and the director of the Pacific Neuroscience Institute’s Pacific Brain Health Center in California who was not involved in the study, told Medical News Today he found it surprising that 99% of primary care doctors under-diagnose MCI.

But he also said it fits with stories he’s heard.

“I’ve heard from the patients in our specialty brain health center that when they’d asked their primary care doctor for help with mild memory changes, they were offered false reassurances about there not being a memory problem,” Merrill said. “Or worse, if a problem is acknowledged, the falsehood is stated that there’s nothing worth trying or doing to change the memory loss.”

Merrill said doctors underestimating what can be done makes patients vulnerable to putting off addressing suboptimal health risk factors or making lifestyle changes and not seeking treatments until it’s too late.

“Once dementia is diagnosed, many of the brain cells in critical areas for memory formation are already dead,” Merrill said. “Treatment is best started as early as possible, before irreversible loss of brain cells.

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