How to recognise mild cognitive impairment in elderly

Many of us face the daunting role of looking after parents as they age

One problem which can cause  particular concern is worsening memory leading to questions about whether our loved one is developing dementia

But how do we tell if this is just normal ageing or something more serious?

It is not well known, but dementia often starts 10-15 years before its effects become apparent to friends and relatives

The condition can be split into seven stages

The first three stages are often subtle and difficult to distinguish from age-related memory decline

It is part of normal aging to develop some short term memory lapses and forgetfulness as our brain tissue naturally experiences neurone attrition from middle age onwards

However, mild cognitive impairment tends to indicate more progressive memory decline.

Mild cognitive impairment is present when a clinically validated cognition test reveals some deficits such as impaired short term memory, poor attention, naming difficulties

Often signs and symptoms from this period can last a number of years before medical attention is sought

I have also seen many intelligent patients, or those from a professional background,  who have “normal” cognition on testing, but the history from friends and family suggests something more sinister

First 3 stages of Dementia

1. No impairment (normal function)

The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia.

2.  Very mild cognitive impairment (may be normal age-related changes, or earliest signs of Alzheimer’s disease)

The person may feel as if he or she is having memory lapses — forgetting familiar words or the location of everyday objects., but no symptoms of dementia can be detected during a medical examination or by friends, family or colleagues

3. Mild cognitive impairment (early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms)

Friends, family or colleagues begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common stage 3 difficulties include:

•  Noticeable problems coming up wit the right word or name
• Trouble remembering names when introduced to new people            
• Having noticeably greater difficulty performing tasks in social or work settings
• Forgetting material that one has just read         
• Losing or misplacing a valuable object               
• Increasing trouble with planning or organizing

Source: Alzheimer’s Association

• Early diagnosis is a controversial subject in the medical community, as unfortunately there are not many well validated treatments to address mild cognitive impairment
• Often older people who develop memory problems may minimise the impact on their daily functioning despite concern from their relatives
• Having said that, a considerable amount can be done from a lifestyle perspective to address early cognitive decline and mitigate some of the problems that arise in daily functioning
• Daily exercise, a healthy diet, social activities and cognitive stimulation in the form of intellectual pursuits or hobbies are important in building good “brain health”
• My own experience of being a dementia physician working in an NHS memory clinic made me realise some of the practical problems that arose from MCI and those affected
• For instance, if a loved one is living alone, they may be affected by social isolation and loneliness, which is now recognised as playing  a significant role in worsening cognitive function and various illnesses
• Unfortunately in the UK, many Local Authorities and NHS organisations have restricted eligibility for people with “milder” support needs, which has meant that services such as day centres and meals on wheels are no longer available
• This can often mean that an older loved one can spend much of the week without social contact
• In response to these challenges, I developed HomeTouch, an online marketplace for care that helps families select carers who specialise in everything from companionship to dementia care. Finding quality and affordable care is an  challenge for families and this service helps to select vetted and well matched carer nearby.

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