What’s the Difference Between Mild Cognitive Impairment (MCI) and Dementia?

Apr 2, 2019 | Dr. Anne Shandera-Ochsner, HABIT Midwest Director | @dranneshanderaochsner | Comments (36)

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As a neuropsychologist, I often see patients who are concerned about the possibility that they have Alzheimer's disease. When we discuss their test results and diagnosis, I often get questions such as “what's the difference between Alzheimer's disease and dementia?” Or “what's the difference between mild cognitive impairment and dementia?”

Both mild cognitive impairment (MCI) and dementia are umbrella terms, meaning that they are broad or general ways of defining a condition that can have many different, specific causes.

How are they similar?

Both MCI and dementia involve having cognitive skills that are not normal for age. For many people, this is memory impairment. But, other people have difficulty with language functioning, thinking speed, visuospatial skills, problem-solving, or attention. Both MCI and dementia are diagnosed through a series of medical and cognitive evaluations, typically including: bloodwork, brain imaging (such as CT or MRI), neuropsychological evaluation, and a careful history-taking to rule out other causes of thinking difficulty by a physician, psychologist, or both.

Both MCI and dementia can be caused by the following:

  • Alzheimer’s disease
  • Cerebrovascular disease (including stroke)
  • Parkinson’s disease
  • Lewy Body disease
  • Frontotemporal degeneration

How are they different?

The main difference between MCI and dementia comes down to how folks are functioning in day-to-day tasks. People with MCI are still pretty independent with their daily functioning. They usually are still driving, cooking, paying bills, and taking care of the house. Some are even still working. They may use systems, strategies, or other aides (like a pill organizer) to keep themselves independent.

People with dementia, on the other hand, have cognitive difficulties that have progressed to the point that they interfere with the person being able to be independent in her daily life. Therefore, they may have family members or healthcare assistance who administer their medications to them, do the cooking, and/or provide transportation. A person with dementia typically would not be able to hold down a job.

In addition, people with MCI may have only one area of thinking difficulty (often memory), with normal thinking abilities in other domains. People with dementia usually have global cognitive impairment or problems in multiple cognitive domains.

Chime in - how could healthcare professionals do a better job of explaining the difference between MCI and dementia when providing the initial diagnosis?

@dranneshanderaochsner – Wow! That is a really powerful punch of information in a short space. Thank you! One of the things that interests me is information about the progression from MCI to dementia. My husband was diagnosed with MCI and he has progressed into dementia – but what were the milestones? I didn't know what to look for. In a way, it's like getting old… it happens so gradually. When do you cross over from young to old? When is it MCI and when is it dementia? One day your loved one has some manageable cognitive issues, the next time you notice you are in a totally different situation. I know that even within dementia there are levels of progression. I would love to learn more so I could be prepared. Again, thanks for a really great article.

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@debbraw

@dranneshanderaochsner – Wow! That is a really powerful punch of information in a short space. Thank you! One of the things that interests me is information about the progression from MCI to dementia. My husband was diagnosed with MCI and he has progressed into dementia – but what were the milestones? I didn't know what to look for. In a way, it's like getting old… it happens so gradually. When do you cross over from young to old? When is it MCI and when is it dementia? One day your loved one has some manageable cognitive issues, the next time you notice you are in a totally different situation. I know that even within dementia there are levels of progression. I would love to learn more so I could be prepared. Again, thanks for a really great article.

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@debbraw – Good questions! The "milestones" of progression from MCI to dementia can be subtle from day to day, so you are spot on in your analogy of this being like the aging process. For healthcare providers, who see the patient every 6 months or every year, changes appear a bit more pronounced. What many of us tend to hone in on is how the person is functioning in daily life. Usually, when MCI progresses, we hear about a patient having had some mishaps with medication management, bill paying, cooking, or driving tasks, to the point that family members have stepped in and taken over some or all of those things. Essentially, that loss of function is a symptom of cognitive difficulties getting worse, with progression of the underlying disease. You are also right that dementia has stages (mild, moderate, severe). I'd suggest taking a look at the Alzheimer's Association website resources for more info on that (https://www.alz.org/alzheimers-dementia/stages).

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@dranneshanderaochsner – The link you provided was helpful. Its such a cruel disease. I appreciate all of you at Mayo who are helping us cope – both the patients and those of us who are partners and spouses. If you ever wonder whether you are making a difference in the world, I'm here to tell you YES! Thanks so much.

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@debbraw

@dranneshanderaochsner – The link you provided was helpful. Its such a cruel disease. I appreciate all of you at Mayo who are helping us cope – both the patients and those of us who are partners and spouses. If you ever wonder whether you are making a difference in the world, I'm here to tell you YES! Thanks so much.

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I truly appreciate this information. The more information we have about the progress of MCI the better we can handle caring for our loved one. It is truly an insidious disease. It robs the person of their dignity and purpose in life. It breaks my heart to watch my husband realize he can’t do things that use to be so simple for him to do. Thank you for any and all information you can share with us! Carol

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@debbraw

@dranneshanderaochsner – The link you provided was helpful. Its such a cruel disease. I appreciate all of you at Mayo who are helping us cope – both the patients and those of us who are partners and spouses. If you ever wonder whether you are making a difference in the world, I'm here to tell you YES! Thanks so much.

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Thank you, Debbra!

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If you lived with someone with MCI, you would soon learn, as I did, that inconsistency is the rule of each day. It depends on the mood or attitude of the person at a particular time, so it is difficult to asses whether the person is being difficult, stubborn, or just unable to be cooperative in his or her thinking.
So you must learn a peaceful response to every episode because to argue or criticize or correct the thinking or action just makes everything worse.
Early on, you learn not to ride with them when they are driving, as it may not be safe. You remember to not respond to their directions in a quiet way so they may not notice that you did not follow through. You hide your strong pain meds so they don't steal them. They may eat unsafe food from the refrigerator so you check the dates and clean out often because lack of taste or smell is an early warning sign of trouble. The hardest part is that you never know if they are being "foggy" in their thinking or if it is just stubborn refusal to cooperate as a fight to maintain their independence. Do not wait to find out. Protect yourself if you wish to outlive a person with MCI. And get control of the money needed to get everyone through the ordeal. It may take years!

REPLY
@debbraw

@dranneshanderaochsner – Wow! That is a really powerful punch of information in a short space. Thank you! One of the things that interests me is information about the progression from MCI to dementia. My husband was diagnosed with MCI and he has progressed into dementia – but what were the milestones? I didn't know what to look for. In a way, it's like getting old… it happens so gradually. When do you cross over from young to old? When is it MCI and when is it dementia? One day your loved one has some manageable cognitive issues, the next time you notice you are in a totally different situation. I know that even within dementia there are levels of progression. I would love to learn more so I could be prepared. Again, thanks for a really great article.

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The important thing to remember is that the progression is not always consistent so some days go better than others. It is a full time job to remain calm and not argue with their "facts." It is important to protect yourself, especially when they drive. It is important to get control of the money needed to get through the coming years. Don't wait. In the beginning, take every strange event seriously. Do not believe the lies they tell to cover up their foggy brains. They know their is a problem but they are in denial or they believe it doesn't matter.
Dorisena

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Oops! I meant to say "there" instead of "their." So maybe I am declining a little, as I usually am very good at the proper English to use. Or, perhaps my fingers do not want to behave this morning and I go too fast. At least I still remember what my teacher taught me in elementary school. Dorisena

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@debbraw

@dranneshanderaochsner – Wow! That is a really powerful punch of information in a short space. Thank you! One of the things that interests me is information about the progression from MCI to dementia. My husband was diagnosed with MCI and he has progressed into dementia – but what were the milestones? I didn't know what to look for. In a way, it's like getting old… it happens so gradually. When do you cross over from young to old? When is it MCI and when is it dementia? One day your loved one has some manageable cognitive issues, the next time you notice you are in a totally different situation. I know that even within dementia there are levels of progression. I would love to learn more so I could be prepared. Again, thanks for a really great article.

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I noticed something missing from the discussion on gradual decline that I observed in my life. If a male spouse doesn't do many of the daily independent actions for years on end because his spouse does it for him, he naturally declines in that area, under the idea that if you snooze, you lose the ability. In other words, having a servant at the meal table means you learn, or forget to do many actions for your self. My husband's grandmother served him standing up during a meal, as was her cultural custom, and she ate later in the kitchen. For fifty years my husband never thought to rise and get a missing bottle of ketchup for his use, and all condiments on the table had to be passed to him, as he never learned the initiative to reach for anything himself. He was served, like a King! After forty years of marriage I announced at the table of six people that I had worked hard on the dinner, and if anything was missing or they needed anything extra, they should get it themselves so I could sit and eat with them at the table. My husband never complied. He sulked and I ignored it.
At that point if I left him or died he would not be able to feed himself and my family realized we had a problem for the future. Was it MCI or poor training? Was it power play, stubbornness, or expecting a slave mentality from the spouse? Or was it MCI? He quit using soap in the shower. He never turned off a light switch. He became a burden to everyone to live with. Eventually it became dementia.
Dorisena

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@dorisena

If you lived with someone with MCI, you would soon learn, as I did, that inconsistency is the rule of each day. It depends on the mood or attitude of the person at a particular time, so it is difficult to asses whether the person is being difficult, stubborn, or just unable to be cooperative in his or her thinking.
So you must learn a peaceful response to every episode because to argue or criticize or correct the thinking or action just makes everything worse.
Early on, you learn not to ride with them when they are driving, as it may not be safe. You remember to not respond to their directions in a quiet way so they may not notice that you did not follow through. You hide your strong pain meds so they don't steal them. They may eat unsafe food from the refrigerator so you check the dates and clean out often because lack of taste or smell is an early warning sign of trouble. The hardest part is that you never know if they are being "foggy" in their thinking or if it is just stubborn refusal to cooperate as a fight to maintain their independence. Do not wait to find out. Protect yourself if you wish to outlive a person with MCI. And get control of the money needed to get everyone through the ordeal. It may take years!

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Dorisena, This is exactly what I needed to see… your response. I moved to our second bedroom last night with the door locked! My husband and I had a nice outing then came home to be shouted at about who knows what. His mood changes on a dime. I found out he bought a gun… his first although he did have one my father had given him. We took it when he was first diagnosed and didn’t miss it. My son who is in law enforcement tried to reason with him to get it away, but he fefused. We changed the lock on the case. My husband said he wanted to go target shooting since he can no longer fly a plane or play golf. Friends have disappeared. His Mayo neurologist did not make a big deal of the gun—- he compared it to a fishing pole. My husband was a high ranking officer in the military so I guess his Mayo doc thought he was used to guns… not!! My husband carried a gun on a three month mission otherwise had to go to the firing range once a year to qualify. Never hunted, never went target shooting.

I am frightened of my husband’s frequent mood changes. I am tired of living afraid. He has only been verbally abusive, not physical yet. Our physician told me to take him to the VA yesterday telling my husband it was for back pain he is constantly complaining of… had surgery on back in December. I was then to tell the VA doc I feared for his safety and mine. He would not go. I don’t know what to do. Divorce because an anoxic brain injury broke an otherwise good man and father? I am at a loss.
I too have to stay on top of cleaning out the fridge. Caught him eating old sliced turkey but why should I care? Won’t let me pay the bills or do them together. I get blamed for everything that goes wrong. My nerves are shot!

Forgive typos. I have eye problems.

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@janeejane

Dorisena, This is exactly what I needed to see… your response. I moved to our second bedroom last night with the door locked! My husband and I had a nice outing then came home to be shouted at about who knows what. His mood changes on a dime. I found out he bought a gun… his first although he did have one my father had given him. We took it when he was first diagnosed and didn’t miss it. My son who is in law enforcement tried to reason with him to get it away, but he fefused. We changed the lock on the case. My husband said he wanted to go target shooting since he can no longer fly a plane or play golf. Friends have disappeared. His Mayo neurologist did not make a big deal of the gun—- he compared it to a fishing pole. My husband was a high ranking officer in the military so I guess his Mayo doc thought he was used to guns… not!! My husband carried a gun on a three month mission otherwise had to go to the firing range once a year to qualify. Never hunted, never went target shooting.

I am frightened of my husband’s frequent mood changes. I am tired of living afraid. He has only been verbally abusive, not physical yet. Our physician told me to take him to the VA yesterday telling my husband it was for back pain he is constantly complaining of… had surgery on back in December. I was then to tell the VA doc I feared for his safety and mine. He would not go. I don’t know what to do. Divorce because an anoxic brain injury broke an otherwise good man and father? I am at a loss.
I too have to stay on top of cleaning out the fridge. Caught him eating old sliced turkey but why should I care? Won’t let me pay the bills or do them together. I get blamed for everything that goes wrong. My nerves are shot!

Forgive typos. I have eye problems.

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Yes, I am willing to share my experiences and how I managed to live through the problem. I wrote a reply but it was too long for the space so I lost it. The HIPPA law allows a patient to refuse treatment and drive his family nuts if he chooses. A compulsive spouse will come after you even if you try to use the court, and most judges are not qualified to make a judgment about mental disease. Feel free to private message me. I can be supportive, at least. My husband wanted to take me to the Grand Canyon to see the beautiful view, and I had already been there and knew I would never come back except perhaps in a box so I used my bad back as an excuse not to accept his generous offer. He died of a tumor on the spine 12 years ago. He had diabetes, obesity, alcoholism, drug addiction due to pain, and was abusive, selfish and did not provide financially well enough for me to make ends meet. He was a con artist businessman and the church was full at the funeral. Dorisena

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@dorisena

Yes, I am willing to share my experiences and how I managed to live through the problem. I wrote a reply but it was too long for the space so I lost it. The HIPPA law allows a patient to refuse treatment and drive his family nuts if he chooses. A compulsive spouse will come after you even if you try to use the court, and most judges are not qualified to make a judgment about mental disease. Feel free to private message me. I can be supportive, at least. My husband wanted to take me to the Grand Canyon to see the beautiful view, and I had already been there and knew I would never come back except perhaps in a box so I used my bad back as an excuse not to accept his generous offer. He died of a tumor on the spine 12 years ago. He had diabetes, obesity, alcoholism, drug addiction due to pain, and was abusive, selfish and did not provide financially well enough for me to make ends meet. He was a con artist businessman and the church was full at the funeral. Dorisena

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I would speak up and do anything to convince the medical community that many are living in dangerous marriages and will not leave because of their moral desire to fulfill their marriage vows to God and because the courts are not equipped to provide the protection needed to keep them safe. It is more than domestic violence. It is mental illness combined with a controlling attitude given mostly to men who were taught they are to be in charge of everything and they have the right to rule over others. When their mind declines for whatever reason, alcoholism, brain damage from diabetes, traumatic childhood, financial ruin, you name it, or even a lack of ability to love, divorce won't solve the problem. We need to fight back with everything at our disposal, and we need the medical profession to help us.
dorisena

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