This broad overview mild cognitive impairment covers the signs and symptoms, assessment and diagnosis, and management approaches.
Basic facts about mild cognitive impairment.
Mild cognitive impairment or MCI, occurs when an individual acknowledges that their memory and thinking skills have shown some signs of decline. The individual’s family and friends will most likely notice the same.
Your doctor or health care team might also use the term, “Mild Neurocognitive Disorder”. The essence of MCI is that a person’s cognitive functioning is worse than expected but not bad enough to be considered as dementia.
Estimates vary, but roughly 10-20% of people over age 65 have MCI, with the risk increasing as someone gets older.
People with mild cognitive impairment are at a higher risk of developing dementia, with 10-15% of people with mild cognitive impairment developing dementia each year.
MCI can be caused by all of the same things that cause dementia, such as Alzheimer’s disease. It can often be hard to find the cause of MCI, but it’s important for the health care team to do a full assessment to try to manage any underlying causes. Some potential causes include:
The risk of developing MCI increases as someone gets older. Conditions such as diabetes, depression, and stroke may also increase a person’s risk for MCI.
Research suggests that genetic factors may play a role in who will develop MCI, as they do in Alzheimer’s and related dementias.
Signs and symptoms of mild cognitive impairment.
The cognitive changes that people with MCI show are more obvious on testing than those with normal aging. Everyday tasks or functions might take more effort for the person with MCI, or they might need to find ways to make up for their cognitive changes; like writing down reminders to make up for a worsening of their memory.
People with MCI tend to be troubled by the inability to complete tasks or function in their day-to-day lives the way they used to. People with normal age-related changes are not impacted to the same degree as those with MCI.
In MCI, everyday functioning is less impaired than dementia. People with MCI can still function independently with all of their day-to-day functions. In contrast, people with dementia have cognitive decline to a point where it significantly interferes with their independence in everyday activities.
MCI-related memory problems may include:
Signs that it might be time to talk to a doctor include:
Many people with MCI also experience emotional symptoms such as:
Have a look at the table below to compare and contrast some of the changes that may occur with age vs. those associated with MCI or dementia.
|Mild Cognitive Impairment
|Subtle cognitive changes
|Cognitive decline is worse than normal aging
|Cognitive decline is worse than MCI
|Cognitive tests are likely to be normal
|Symptoms are more obvious on cognitive tests
|Cognitive tests typically reveal obvious issues
|There is an ability to perform tasks almost as well as before
|Tasks take more effort or need workarounds
|Assistance may be needed for many tasks
|There is less impact on day-to-day function
|Presence of an impact on day-to-day life, which can be frustrating
|Loss of independence for many functional tasks
Assessment and diagnosis.
MCI is assessed and diagnosed by a health care provider; usually a family physician or specialist physician like a geriatrician or neurologist. Most often, a person will go to their doctor with complaints of memory and thinking problems; sometimes families are the first to notice changes and may encourage their loved one to get an assessment.
There are a few different aspects to a comprehensive assessment:
It’s important to keep in mind each person’s background and previous cognitive strengths when assessing MCI. If somebody was previously an investment banker, and now they have difficulties completing their taxes, that’s a particularly worrisome sign given their previous skills and experience. They may only have MCI now, but they should be monitored for worsening of their cognitive problems.
While not routinely requested, more detailed cognitive testing other than the MoCA and MMSE can be performed by a neuropsychologist. If these more detailed tests are abnormal, people are at a higher risk of progressing to dementia.
Levels of toxic proteins can sometimes be measured in the fluid that surrounds the brain by gaining a sample of fluid from a spinal tap (or lumbar puncture). In research studies, people have used these levels of proteins to predict progression from MCI to dementia, but these are currently not used outside of research studies in Canada at this time.
There is an evolving area of interest looking for ‘biomarkers’ (like toxic proteins), which are biological molecules found in blood, other body fluids, or tissues that could be a sign of disease. But this is still at a research stage for conditions like MCI and dementia, and not measured as a part of a typical assessment.
As we age, some of our cognitive abilities gradually decline:
People with MCI are at a greater risk of developing Alzheimer’s disease or a related dementia. Estimates vary as to how many people who have MCI will develop dementia. Roughly one to two out of 10 people age 65 or older with MCI are estimated to develop dementia over a one-year period. However, in many cases, the symptoms of MCI stay the same or even improve.
There is a chance that the severity of the cognitive impairments and problems with independent functioning will progress to dementia.
Some people with MCI will improve and regain their previous cognitive function, some people will remain the same for many years, and some people will progress to have dementia. It is estimated that people with MCI have about a 5-10% increased chance of progressing to dementia per year. Generally, the severity of memory, thinking, and function problems predicts if and how the disease will progress; but it also depends on the underlying cause of the MCI.
Have a look at the table below to compare and contrast MCI and dementia.
|Mild Cognitive Impairment
|Cognitive changes are less severe
|More severe cognitive impairments
|Day-to-day life is impacted but can still function independently
|Cognitive decline interferes with independent function
|Complex tasks may take longer
|Complex tasks likely too hard to do
No one specific test is used to diagnose MCI. After doing the comprehensive assessment, including history, physical exam, cognitive screening, and investigations to rule out other potential causes of cognitive impairment, the doctor will be able to give you the diagnosis of MCI.
Typically the diagnosis is based on the presence of these criteria:
The American Psychiatric Association’s DSM-5-TR (the standardized diagnostic manual used in North America) defines Mild Neurocognitive Disorder (their new terminology for MCI) with very similar criteria:
If possible, the doctor might try to determine a ‘possible’ or ‘probable’ cause for the Mild Neurocognitive Disorder/MCI.
Management of MCI.
Treatments for mild cognitive impairment depend on the underlying cause of MCI.
At this time, there are no specific medicines that are approved for the treatment of MCI. Medicines that are used in the management of Alzheimer’s disease known as ‘cognitive enhancers’ (cholinesterase inhibitors) aren’t usually recommended for the treatment of MCI. So far studies haven’t shown that these medicines reduce the risk of MCI progressing to dementia, and they frequently have side effects.
People with some forgetfulness from MCI can use a variety of techniques that may help them stay healthy and deal with changes in their memory and mental skills. Here are some tips:
Learn more about things you can do to promote brain health.
Prognosis, what to ask your health care provider, as well as other references and resources.
If you have MCI, visit your health care provider every six to 12 months to track changes in memory and other thinking skills over time.
Although the cognitive problems may not improve or worsen, people with MCI can take steps to limit their impact, as outlined above under Treatment. Because there are likely a range of different causes of MCI, it’s difficult to predict who will have improvements, who’s MCI remains stable, and who will get worse. If the MCI is due to Alzheimer’s disease or one of the other progressive causes of dementia, then the MCI will eventually worsen. If you have another medical illness and that condition is not well-controlled, that may also impact your MCI. Similarly, some medication side effects or substances like alcohol could also worsen your MCI.
While it may not be possible to prevent MCI in all cases, research shows it is possible to reduce your risk of getting MCI or dementia through several key lifestyle factors. Some of the key factors include:
General brain health may be improved with the right combination of diet, exercise, social activity, and managing blood vessel health (such as blood pressure and blood cholesterol control). Diabetes management and cognitive training may also be somewhat helpful. The more of these lifestyle behaviours that you can do, the better.
Please see the e-learning lesson on Promoting Brain Health for further information.
Talk with your doctor or nurse practitioner to determine whether memory and other cognitive problems, such as the ability to clearly think and learn, are normal and what may be causing them.
Be specific about the changes you’ve noticed. For example, you could say: “I’ve always been able to balance my budget without any problems, but lately I’m very confused.” Ask any family or friends who have noticed changes to provide examples that you can share. Your doctor will probably want you to have a thorough check-up to see what might be causing your symptoms.
It is often helpful to bring a written list of your questions, in order of importance. Write down your symptoms, and bring along a family member or friend to the appointment, if possible. It’s helpful to make a list of your other medical conditions and all of your medications, including any over-the-counter drugs or supplements that you take.
For cognitive changes, some questions to consider asking your provider include:
Family/friend care partners of people living with cognitive impairment are at increased risk of mental health issues like depression and anxiety. It’s important that you look after your own mental and physical health if you are a care partner for someone with MCI. Learn more about caregiver wellness from our iGeriCare e-learning lesson.
In addition to talking with your health care team, the following resources may also be helpful for you.
If you haven’t reviewed our e-learning lesson about Mild Cognitive Impairment, that’s another good educational resource.
On the McMaster Optimal Aging Portal, we have several evidence-based articles related to MCI, including the following:
Putting it all together.
You can learn more about reducing your risk of dementia by reviewing our Promoting Brain Health topic.
This page was developed by the Division of e-Learning Innovation team and Dr. Anthony J. Levinson, MD, FRCPC (Psychiatry). It was based on content originally co-authored by Dr. Richard Sztramko (geriatrician) and Dr. Levinson, who is a psychiatrist and professor in the Department of Psychiatry and Behaviour Neurosciences, Faculty of Health Sciences, McMaster University. He practices Consultation-Liaison Psychiatry, with a special focus on dementia and neuropsychiatry. By the way, no computer-generated content was used on this page. Specifically, a real human (me) wrote and edited this page without the help of generative AI like ChatGPT or Bing's new AI or otherwise.
Dr. Levinson receives funding from McMaster University as part of his research chair. He has also received several grants for his work, from not-for-profit granting agencies. He has no conflicts of interest with respect to the pharmaceutical industry; and there were no funds from industry used in the development of this website.
The page was created in January and February, 2023. It was last reviewed and updated February 23, 2023.
Content was written and adapted based on credible, high-quality, non-biased sources such as MedlinePlus, the National Institutes for Mental Health, the McMaster Optimal Aging Portal, the American Psychiatric Association, the American Neurological Association, the Cochrane Library, the Centre for Addictions and Mental Health (CAMH) and others.
Funding was provided by the Labarge Optimal Aging Initiative and in-kind contributions from McMaster University and CAMH. Some of the content was adapted from the original materials developed for the iGeriCare.ca dementia education resource, with funding provided by the Centre for Aging and Brain Health Innovation (CABHI), powered by Baycrest. There was no industry funding for this content.
Helpful Links and Resources
Expert-selected websites and documents related to cognitive impairment.
Free, award-winning, online dementia education resource from McMaster University.View Resource
Alzheimer Society of Canada
The Alzheimer Society of Canada is the leading nationwide health charity supporting people living with all forms of dementia, including Alzheimer’s disease, as well as their caregivers and their families.View Resource
211 is a great resource for information about government and community-based social services, as well as some non-clinical health services. It’s a free and confidential service operating in pretty much every province and territory, and serving people in more than 150 languages, by phone, chat, text, and web.View Resource
McMaster Optimal Aging Portal
Free, continuously updated website with healthy aging information that you can trust from McMaster UniversityView Resource
10 Effective Memory Strategies PDF Download
Memory changes are often a part of normal aging. This PDF download has 10 tips from Sinai Health System can help to navigate everyday memory challenges.View Resource
Understand the signs and symptoms of anxiety, its diagnosis, and treatment options.Anxiety
Understand the signs and symptoms of depression, its assessment, and treatment options.Depression
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