Mild Cognitive Impairment Missed by Many Primary Care Offices

Have you ever misplaced your glasses? Or walked into a room only to forget why? For years, mild forgetfulness was considered a normal part of aging often triggered by being in a noisy environment, dealing with stress or multitasking.

But researchers also think these memory lapses may be an early sign of cognitive issues. Mild forgetfulness may be a sign of mild cognitive impairment (MCI), which may lead to Alzheimer’s or other neurodegenerative diseases, according to a study conducted by University of Southern California researchers and published in Alzheimer’s Research and Therapy.

Diagnosing and treating MCI is important. There are numerous causes of mild cognitive issues, including hyperthyroidism and medication side effects, which can be reversed. In other cases, the condition can be stabilized with lifestyle modifications. And new medications may help tackle the underlying biology associated with dementia and slow the disease progress.

Unfortunately, MCI often goes undetected during physician visits, according to a study conducted by the same research team and published in The Journal of Prevention of Alzheimer’s Disease. In fact, this study estimates that 99 percent of primary care doctors under-diagnose MCI, suggesting an urgent need for early detection in primary care offices.

The study found that doctors weren’t catching MCI during standard wellness visits. They may not be performing the cognitive screenings or may not be scheduling wellness visits, the author’s wrote.

What Is Cognitive Function?

To understand cognitive impairment, you need understand cognitive function, a term used to describe the mental processes involved in gaining knowledge, using information and reasoning. This involves perception, memory, learning, attention, decision making and language abilities.

Cognitive function can decline as you age. In fact, nearly two out of three Americans experience some level of cognitive impairment by age 70, according to the National Institutes of Health.

Cognitive impairment is often described as having trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life. Cognitive decline can be severe, as in the case of dementia and Alzheimer’s or mild as in MCI

What is Mild Cognitive Decline?

For the most part, MCI is a memory decline, but it’s possible to also have personality changes and lack efficiency in getting work/chores done. The changes are usually slight but noticeable.

It’s not fully understood how MCI develops but it affects between 10 and 20 percent of Americans older than 65, according to the Centers for Disease Control and Prevention. Risk factors include advancing age, family history of dementia, particularly Alzheimer’s disease, and issues that contribute to heart disease like high blood pressure and unhealthy cholesterol and triglycerides levels.

Probably the biggest concern with MCI is that it raises your risk for dementia – a far more debilitating problem. One theory is that the brain changes that occur during MCI are the early stages of a neurodegenerative condition that causes dementia, for example, Alzheimer’s disease. Between 10 percent and 15 percent of people with MCI develop dementia each year and about 33 percent of people with MCI due to early-stage Alzheimer’s disease develop dementia within five years, according to the Alzheimer's Association. This is why it’s important that the condition is detected as soon as possible so treatment can begin.

How Is MCI Diagnosed?

Diagnosing MCI, as well as dementia, usually involves a series of assessments:

• Decline of memory and/or other mental functions determination - Your doctor may talk to close family members and friends and rely on your medical history to help determine if you may have MCI and if it’s interfering with memory, planning, following instructions and/or making decisions. 
• Unaffected daily activities assessment - Your doctor may talk to you and close family member and friends to assess if you can continue living your life as usual.
• Mental status tests - Your doctor may use the Short Test of Mental Status, the Montreal Cognitive Assessment or the Mini-Mental State Examination to help gauge the level of impairment for your age and education level, the types of memory most affected and other cognitive functions that may be impaired. Your doctor may want you to undergo longer status testing.
• Neurological screenings - Your doctor may check some neurological functions like reflexes, eye movements and walking and balance during your physical examination. Data gathered from these screenings can help your doctor detect signs of Parkinson’s disease, stroke, tumors and other issues that may affect your cognitive skills.
• Lab tests – Your doctor may order bloodwork to measure thyroid function or vitamin B-12 levels to rule out physical conditions that may appear as cognitive decline.
• Brain imaging – Your doctor may arrange for imaging such as an MRI or CT scan to check for a brain tumor, stroke or bleeding.

If you meet criteria for MCI but not dementia, your doctor will probably continue monitoring you. However, if results from screenings and tests suggest dementia and elevated beta-amyloid levels, your doctor may refer you to a specialist and/or have you begin taking lecanemab, an antibody intravenous infusion therapy that helps remove beta-amyloid from the brain. The FDA approved its use for MCI, early Alzheimer’s disease and mild dementia related to Alzheimer’s disease.  

“As you age, it’s very important to establish a strong relationship with your primary care physician, as the better your doctor knows you, the better positioned they will be to address and respond to indications of MCI,” says Bernard Kaminetsky, MD, medical director, MDVIP. “This is one of the reasons MDVIP-affiliated practices are smaller than traditional primary care practices – it enables doctors to developed deeper, more meaningful relationships with their patients.”

If you don’t have a doctor, consider joining an MDVIP-affiliated practice. As part of the MDVIP Wellness Program, your doctor can help you live a brain healthy lifestyle. Find an MDVIP affiliate near you and begin your partnership in health »