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Mild Cognitive Impairment

Megan L. Malone, MA, CCC-SLP, Jennifer Loehr, MA, CCC-SLP

February 18, 2016

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Question

What is MCI and what causes it?

Answer

According to the Alzheimer's Association, Mild Cognitive Impairment (MCI) is something that causes cognitive changes that are serious enough to be noticed by the individuals experiencing them or other people, but the changes are not severe enough to interfere with daily life or function. That is really the discriminating feature between MCI and dementia or Alzheimer's disease.  Certain things are bothersome to the person and are a little more difficult than they used to be, but those changes do not really affect how they get through daily life. 

Because the changes caused by MCI are not severe enough to affect daily life, the person with MCI does not meet the diagnostic guidelines for dementia. The key phrase, again, is “daily life”. Those with MCI have an increased risk for eventually developing Alzheimer's or another type of dementia, however not all people with MCI get worse and some actually can get a little bit better.

Overall, there is a limited understanding of the causes of MCI because many of these folks go undiagnosed. When there is a little forgetfulness here and there, a little cognitive dysfunction and nothing very serious going on, many individuals will keep it to themselves.  They don't want anyone to know so they do not seek treatment for it. Additionally, many people think this is a normal part of aging.  There is not much research in this area although awareness is increasing, especially on medical websites such as the Alzheimer’s Association.

Medication side effects - Overall, there are some causes of mild cognitive impairment. Medication side effects or mismanagement is a big one. Medication errors in the elderly is one of the main causes for re-hospitalization. Those who may work in the home health realm understand what re-hospitalization is. Folks who have MCI are not necessarily forgetting to take their meds altogether, many of them are double dosing because they forget that they already took their medication. This is a cause, that toxicity in the bloodstream, is a cause for MCI.

Illness or infection - You and I could walk around with an infection, perhaps a urinary tract infection, and may feel very few symptoms or maybe a little discomfort.  But for those who older, these illnesses or infections can take over the whole body, especially the UTIs and the respiratory infections. That can cause this mild cognitive impairment.  This would be considered temporary and reversible.            

Nutrition/hydration depletion - If an elderly person has an illness or infection, typically there are many other issues that are going to happen.  If the older person is not feeling well then they may sleep more often which means they may be skipping meals or are not drinking enough fluids. When a person does not get proper nutrition then they are not getting the vitamins or proper nourishment they need.  They could then demonstrate a cognitive decline as well as symptoms of dehydration.  One of the hallmark symptoms of dehydration is cognitive impairment. 

Biomarkers - Researchers are starting to look at biomarkers. These are excess proteins in the blood that show up in a blood test. This is one of the indications that somebody may be progressing to dementia, those who have mild cognitive impairment. It is good idea to encourage your patients to get extensive blood work done, if there is some question regarding MCI.

Advancing age – Finally, advancing age, family history of Alzheimer's or other dementia and conditions that raise risk for cardiovascular disease increase the risk for MCI advancing into full blown dementia. However, it does not always happen. Having MCI does not automatically mean a person will develop into further dementia.


megan l malone

Megan L. Malone, MA, CCC-SLP

Megan Malone is a speech-language pathologist working as a Clinical Instructor at Kent State University and in home health care for Gentiva Health Services. She previously worked for 9 years as a senior research associate and lead trainer at Myers Research Institute, in Cleveland, OH where she oversaw federally/privately funded grants focused on implementing interventions with older adults with dementia. She has spoken numerous times at the annual conventions of the American Speech and Hearing Association, Gerontological Society of America, American Society on Aging, and the Alzheimer’s Association, along with several state speech and hearing conventions. She has published articles in the Journal of Communication Disorders, Alzheimer’s Care Quarterly, The Gerontologist, and Dementia.


jennifer loehr

Jennifer Loehr, MA, CCC-SLP

Jenny Loehr is a speech language pathologist with over 25 years experience working with adult neurology. She has presented at over 20 state and national conferences and online continuing education programs on the topic of dementia. She is the co-author of the book, Here's How to Treat Dementia (Plural Publishing 2013) and is an LSVT certified clinician. She currently works in development and implementation of the Memory Care Program with Encompass home health training and mentoring physical, occupational and speech language pathologists working with the dementia population in the independent and assisted living communities. 


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