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?

I was Diagnosed with MCI a year ago. Tests have shown no digression in the past year, even some improvement. I was Only told I had It. Nothing else. Not anything about progression, what to look for in myself as far as changes to be aware of. My research says some people stay the same for a long time. I do Have memory issues, but I am Fully functioning on my own. Where can I get More specific information about MCI and where can I get Answers to my questions? I fired My neurologist since he has been no help at all. I really Need some real answers.

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I can only tell you what I do on my own to survive and try to keep my mind in reality. I have studied the brain since the 1970's when my mother had a severe bleeding stroke and lived in a speechless state for over six years in a facility. I took college level classes to learn the latest research on aging and the mind and went to Alzheimer's conferences since as a teacher I could qualify to attend. We had a handicapped hired man in our home for thirty years so our family learned much about dealing with issues, and actually he improved over the years until his health failed. I can tell you that diabetes scares me because I watched my husband's mind decline because he did not treat his diabetes, and he was an alcoholic as well. He declined into dementia despite all our efforts and we had no help from his doctors because they believed he should be in charge of his choices. He died of metasticized cancer of the spine. I personally try to exercise every day, and I work two Sudoku puzzles every day after I read two newspapers. I play the piano and I study on the web when I can to learn new things about my health in general. I live alone but try to socialize as much as possible without being a pest. I eat lots of veggies. That's it for now until the medical world comes up with a miracle I haven't read about yet. Work hard on yourself. You deserve it. Dorisena

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I found this article interesting as well as informative. So far a doctor has not mentioned any of these things. How often do I ever speak at an appointment?? We do not easily notice these small changes in ourselves. No one else does either unless it is something major. I live alone and rarely see any one else. I know my speak dyslexic at times and cannot find words or think a word and something else comes out totally unrelated. Mostly I say nothing. I go to the doctor and stare at their back or a lid of a laptop. It seems the norm now. 🙁

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@parus

I found this article interesting as well as informative. So far a doctor has not mentioned any of these things. How often do I ever speak at an appointment?? We do not easily notice these small changes in ourselves. No one else does either unless it is something major. I live alone and rarely see any one else. I know my speak dyslexic at times and cannot find words or think a word and something else comes out totally unrelated. Mostly I say nothing. I go to the doctor and stare at their back or a lid of a laptop. It seems the norm now. 🙁

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You can be your own teacher and defender because you are still interested in being the best you can be. Everyone declines with age, and most people keep working their minds to keep it functioning effectively. Living alone is very difficult, as I have done it for 12 years now and most people don't realize that I need company and comfort for the sad, gloomy days or when I have pain. It takes effort for everyone to keep old bodies working smoothly. The body and mind work together and that is just common sense which you seem to possess. The only thing your doctor diagnosed is that you are slowing down in your thinking, and everyone does that eventually. Are you putting your socks in the refrigerator? If you aren't doing weird things, and you can still fix your meals or afford to eat out, you are as normal as the rest of us. Find someone to talk to who can cheer you on for a life worth living. We are on your team! 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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Hi @dorisena you may have noticed I removed your email from your comment. We recommend not sharing personal contact information in a public online forum. We don't want you to get unwanted spam as a result. Instead we recommend using the private message functionality. However, I would like to point out that by sharing on the forum, as you are right now, your messages benefit many and we can all learn from each other.

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@carollc

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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It is heart crushing.

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@ethanmcconkey

Hi @dorisena you may have noticed I removed your email from your comment. We recommend not sharing personal contact information in a public online forum. We don't want you to get unwanted spam as a result. Instead we recommend using the private message functionality. However, I would like to point out that by sharing on the forum, as you are right now, your messages benefit many and we can all learn from each other.

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Thank you for removing my address because of policy. I thought if it was not good, someone would tell me. I have so much I can share that is helpful because of my years of stressful experiences and because of my research study and seeking advice. We help each other and I really appreciate having the opportunity to serve others. Dorisena

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@lbrockmeier

I was Diagnosed with MCI a year ago. Tests have shown no digression in the past year, even some improvement. I was Only told I had It. Nothing else. Not anything about progression, what to look for in myself as far as changes to be aware of. My research says some people stay the same for a long time. I do Have memory issues, but I am Fully functioning on my own. Where can I get More specific information about MCI and where can I get Answers to my questions? I fired My neurologist since he has been no help at all. I really Need some real answers.

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Hi @lbrockmeier – Welcome to Connect! Glad you are here to learn more about MCI. I know that diagnosis must be terribly scary, but it sounds as if you are doing great – and even having some improvement. My husband was diagnosed with MCI a few years ago and he hasn't been as fortunate as you in maintaining his memory and functioning. When he was diagnosed, we attended a 2-week Mayo Clinic program called Healthy Action to Benefit Independence and Thinking (HABIT). It was a lifesaver for us. Here are a couple of links you might want to check out:
https://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/symptoms-causes/syc-20354578
https://www.mayo.edu/pmts/mc2800-mc2899/mc2815-10.pdf
You'll see that the 2nd link – the flyer – has phone numbers if you want to contact any of the Mayo locations.

And here is a video about the HABIT program that might be helpful:

Do you have a new neurologist after firing the first one? If so, I would expect that you would have been asked to do a followup exam this year or next. Initially, with my husband, they did a complete neuro-psychological exam that took around 5 hours to make the diagnosis. They asked him to come back for a similar followup exam the next year. If you haven't got a new neurologist, I would suggest finding one you like and then asking the questions that are concerning you – including what kind of followup evaluations they want to do to monitor progression. I also had good luck with getting lots of helpful information from our local Council on Aging (COA). Could you make an appointment at your local COA?

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@debbraw

Hi @lbrockmeier – Welcome to Connect! Glad you are here to learn more about MCI. I know that diagnosis must be terribly scary, but it sounds as if you are doing great – and even having some improvement. My husband was diagnosed with MCI a few years ago and he hasn't been as fortunate as you in maintaining his memory and functioning. When he was diagnosed, we attended a 2-week Mayo Clinic program called Healthy Action to Benefit Independence and Thinking (HABIT). It was a lifesaver for us. Here are a couple of links you might want to check out:
https://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/symptoms-causes/syc-20354578
https://www.mayo.edu/pmts/mc2800-mc2899/mc2815-10.pdf
You'll see that the 2nd link – the flyer – has phone numbers if you want to contact any of the Mayo locations.

And here is a video about the HABIT program that might be helpful:

Do you have a new neurologist after firing the first one? If so, I would expect that you would have been asked to do a followup exam this year or next. Initially, with my husband, they did a complete neuro-psychological exam that took around 5 hours to make the diagnosis. They asked him to come back for a similar followup exam the next year. If you haven't got a new neurologist, I would suggest finding one you like and then asking the questions that are concerning you – including what kind of followup evaluations they want to do to monitor progression. I also had good luck with getting lots of helpful information from our local Council on Aging (COA). Could you make an appointment at your local COA?

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@lbrockmeier @debbraw beat me to it – she gives a lot of good suggestions, including finding a neurologist who you feel confident in. Geriatric Medicine providers can be a wonderful resource, as well.

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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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Hi @janeejane, I'm glad that you found this article useful and have connected with members like @dorisena, who has personal experience to share with you.

Having to navigate frequent mood changes and never knowing what to expect are exhausting. No wonder your nerves are frayed. I know that many on Connect have had to manage such conditions, and that you have been getting some ideas from other members here and in the Caregivers group https://connect.mayoclinic.org/group/caregivers/ where this is a common topic of discussion.

However, abuse is never okay, even if the disease may be (part of) the underlying cause. You must keep yourself safe. And I see that you are taking steps to do that. You may also wish to visit the National Domestic Violence Hotline website http://www.thehotline.org/ On this website you will find tips and resources, as well as a phone number to call 1-800-799-7233 or you can use the online chat and get help without saying a word. By calling the Hotline, you can work with professionals to find a safety solution that is right for you.

A gun is something to take seriously. Am I correct in understanding that your husband no longer has access to the gun because the case lock has been changed? Do you keep the ammunition locked up separately?

Do you get respite from caregiving?

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@parus

I found this article interesting as well as informative. So far a doctor has not mentioned any of these things. How often do I ever speak at an appointment?? We do not easily notice these small changes in ourselves. No one else does either unless it is something major. I live alone and rarely see any one else. I know my speak dyslexic at times and cannot find words or think a word and something else comes out totally unrelated. Mostly I say nothing. I go to the doctor and stare at their back or a lid of a laptop. It seems the norm now. 🙁

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@parus It can be tough to ask questions at an appointment, especially with a computer seeming to take up the provider's attention, but it's so important to be an advocate for yourself and speak up! It may be helpful to write down your questions in advance and mention early in the appointment that you brought a list of questions. If you are noticing cognitive changes that concern you, let your provider know, and ask if a neuropsychological evaluation (or updated evaluation, if you have not had one in a year) would be indicated.

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@colleenyoung

Hi @janeejane, I'm glad that you found this article useful and have connected with members like @dorisena, who has personal experience to share with you.

Having to navigate frequent mood changes and never knowing what to expect are exhausting. No wonder your nerves are frayed. I know that many on Connect have had to manage such conditions, and that you have been getting some ideas from other members here and in the Caregivers group https://connect.mayoclinic.org/group/caregivers/ where this is a common topic of discussion.

However, abuse is never okay, even if the disease may be (part of) the underlying cause. You must keep yourself safe. And I see that you are taking steps to do that. You may also wish to visit the National Domestic Violence Hotline website http://www.thehotline.org/ On this website you will find tips and resources, as well as a phone number to call 1-800-799-7233 or you can use the online chat and get help without saying a word. By calling the Hotline, you can work with professionals to find a safety solution that is right for you.

A gun is something to take seriously. Am I correct in understanding that your husband no longer has access to the gun because the case lock has been changed? Do you keep the ammunition locked up separately?

Do you get respite from caregiving?

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Great resources, @colleenyoung – I would add that in general, if you feel your safety is compromised, physically leave the situation immediately and call 911.

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