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?

@dorisena

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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@dorisena – thank you for your comments and willingness to share your experiences with others in the group.

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There could be problems with calling 911 if you feel you are in danger. Defenders of the potentially violent person can rally around that person and decide you are the person with the mental problem and the whole thing boomerangs on you. The main reason I did not share my husband's abuse with others or the professionals is because it could make me look like the bad person instead of the person throwing the tantrum. My husband would lie and tell others how badly I treated him and they believed his stories. He told our sons I refused to fix lunch for him on weekends and the truth was I had supplies to feed him that had to be discarded after he never bothered to come in the house to eat or wanted instant demand cooking when I was involved in other work. And he would never help himself to fix a meal. After he died, I lived in fear of someone charging me with causing his illness and death so I kept very quiet about everything. This delayed my eventual healing process and I suffered from nightmares for months until I gained enough strength in reality to understand that he could never hurt me mentally again. Potential victims need training on how to be safe, nonconfrontational, economically protected, and find reliable support people to get through the crises that arise. Eventually the victim needs to find another place and way of living that protects them because it never gets better with time. I did not leave the marriage for 50 years, however now I realize that I should have in later years after I had a safe place and a little savings. I would have sacrificed time with my grandchildren and I refused to do that. Freedom from mental abuse and control is not a bad goal.

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@dorisena

There could be problems with calling 911 if you feel you are in danger. Defenders of the potentially violent person can rally around that person and decide you are the person with the mental problem and the whole thing boomerangs on you. The main reason I did not share my husband's abuse with others or the professionals is because it could make me look like the bad person instead of the person throwing the tantrum. My husband would lie and tell others how badly I treated him and they believed his stories. He told our sons I refused to fix lunch for him on weekends and the truth was I had supplies to feed him that had to be discarded after he never bothered to come in the house to eat or wanted instant demand cooking when I was involved in other work. And he would never help himself to fix a meal. After he died, I lived in fear of someone charging me with causing his illness and death so I kept very quiet about everything. This delayed my eventual healing process and I suffered from nightmares for months until I gained enough strength in reality to understand that he could never hurt me mentally again. Potential victims need training on how to be safe, nonconfrontational, economically protected, and find reliable support people to get through the crises that arise. Eventually the victim needs to find another place and way of living that protects them because it never gets better with time. I did not leave the marriage for 50 years, however now I realize that I should have in later years after I had a safe place and a little savings. I would have sacrificed time with my grandchildren and I refused to do that. Freedom from mental abuse and control is not a bad goal.

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I remember when I was a teenager my mother brought my grandmother to live with us because she didn't want her in an institution. She was one crazy old woman, with moaning that frazzled all our nerves. After two weeks my father came home from work, took one look at the sad scene in our home, and said "there is a crazy person living in this house. If this keeps up, there will soon be two crazy women living in this house." He told my mother to take her mother back to where she could be cared for, and my mother complied. My grandmother and grandfather both lived institutionalized until their deaths, and they didn't know us or were not sane enough for us to visit. My cousin, a nurse, saw that my grandfather was bathed once a week, by force, usually. My point is that we need to learn enough to protect our own mental health while caring for those whose minds can destroy us as well. Dorisena

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@dorisena

I remember when I was a teenager my mother brought my grandmother to live with us because she didn't want her in an institution. She was one crazy old woman, with moaning that frazzled all our nerves. After two weeks my father came home from work, took one look at the sad scene in our home, and said "there is a crazy person living in this house. If this keeps up, there will soon be two crazy women living in this house." He told my mother to take her mother back to where she could be cared for, and my mother complied. My grandmother and grandfather both lived institutionalized until their deaths, and they didn't know us or were not sane enough for us to visit. My cousin, a nurse, saw that my grandfather was bathed once a week, by force, usually. My point is that we need to learn enough to protect our own mental health while caring for those whose minds can destroy us as well. Dorisena

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Hi, @dorisena – it sounds like you have many experiences and tips to offer those who are living with and/or providing care for those experiencing MCI and then dementia like you shared about with your husband, or the mental decline you witnessed in your grandmother. I'd like to invite you to please share with others in our Caregivers group in this discussion https://connect.mayoclinic.org/discussion/caregiving-for-dementia-sufferers. I'd suggest you might read through some of the past posts as well as post about what you've experienced to help others discussing there.

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Two important things about mental health need to be stressed. First, a person is not fine one day and then has a static mental condition the next day. it is usually a gradual, inconsistent decline, unless there was an injury or something physical like a stroke. My husband was "unreasonable" throughout our marriage, and after some strange episodes, he would be fine the next day and I would blame the outburst on having a bad day. He could pretend to be cooperative and reasonable when it was necessary to do so for business reasons. I couldn't decide if there was a problem to pursue. After twenty years of marriage, he became distant and interested in other woman, in plain view of people in the village. He aggravated me and I decided he wanted me gone, but I was cool about all his strange behaviors because I knew he didn't intend to spend money on any women. Eventually that behavior passed.
The second point is that there is seldom just one mental problem to deal with. It is called comorbidity. I had to deal with alcoholism, OCD behavior, narcissism, diabetes, and overeating disorder at the same time, all the while pretending he was normal because he hid it so well and lied so convincingly.
Our family life became a nightmare until the adult children finally recognized the dementia behavior. But they thought I could handle him. I could not.
They did not recognize the danger I lived in. They thought I was not tough enough on him. There was no reasoning with him after that. He ran around the community in his truck and hung out at a place where he could devour donuts and take a nap. I didn't know where he was during the day. 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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Please contact the H.A.B.I.T. program at Mayo. It will be a life saver for you and a partner.
We now have active follow-up support group meeting that are so valuable.

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@bonniep

Please contact the H.A.B.I.T. program at Mayo. It will be a life saver for you and a partner.
We now have active follow-up support group meeting that are so valuable.

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My husband died 12 years ago of metastatic cancer of the spine after denying his cancer had returned. He never was diagnosed with a mental problem because he lied his way through every exam during his five stays in the hospital the year before he died. He told the hospital he didn't live with his wife so they wouldn't tell me anything. He didn't sign the required paper until his last stay in the hospital.
I stayed because I knew no one could care for him so we lived separately in a huge home unreconciled. He was not home very much at all and when he came in at night he aggravated me with outrageous lies just to torment me. I still study to rationalize his crazy behavior so I can find reasons to forgive the whole thing. The community would never believe my story so I heal in silence, but this group is a good place for me to work on considering reasons for it all. I like to think I took care of him for God because no one else could do it. Dorisena.

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The picture I get on this web is that dementia patients are concerned about their mental health and look for help from the doctors, or family members take them in and they cooperate with the treatment like good little boys. What about the narcissistic bully who lies and cons his way through life and is supposedly a successful businessman and is mentally abusive to his wife and family? I was advised I would get no help from the courts and was told not to try. He could sell an igloo to an Eskimo and charmed waitresses off their feet. Eventually his dementia progressed so that it was easier to stay ahead of his antics and I was careful not to ride in a vehicle with him because his driving was erratic. The police called the office looking for him because he turned left at the light from the right hand lane, being the farm boy that he was as a child. We said we didn't know where he was and they let it go. He was an alcoholic but was never stopped and charged. The cancer stopped him when he could no longer walk. No medical professional would ever help the poor man. Dorisena

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@dorisena

The picture I get on this web is that dementia patients are concerned about their mental health and look for help from the doctors, or family members take them in and they cooperate with the treatment like good little boys. What about the narcissistic bully who lies and cons his way through life and is supposedly a successful businessman and is mentally abusive to his wife and family? I was advised I would get no help from the courts and was told not to try. He could sell an igloo to an Eskimo and charmed waitresses off their feet. Eventually his dementia progressed so that it was easier to stay ahead of his antics and I was careful not to ride in a vehicle with him because his driving was erratic. The police called the office looking for him because he turned left at the light from the right hand lane, being the farm boy that he was as a child. We said we didn't know where he was and they let it go. He was an alcoholic but was never stopped and charged. The cancer stopped him when he could no longer walk. No medical professional would ever help the poor man. Dorisena

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You have gone through a lot and posting is helping you release some stress. It may sound trite but try to be good to yourself. You did your best.

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Thank you so much. This winter I took myself to an extended stay hotel by plane and sat in the sun knitting my granddaughter's afghan. I met new friends and we are planning to get together again next winter at the same place. It has been difficult to allow myself to spend the money on my health and happiness. I am learning to sit in a chair and look outside at the day evolving, with the birds, squirrels, and flowers brightening my life. I never had time for that before. Now I want to remodel the nice storage shed in the corner of the yard into a "playhouse" for me. First I must get rid of the mice. Dorisena

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Hi @dorisena
I agree with @providence1960. You have been through a lot. It also sounds like you'd like to talk about things not related to MCI and dementia. I'd like to direct you to the Groups Directory (https://connect.mayoclinic.org/groups/) so that you can find connection here on Connect to talk with others about things that help you find joy.

To talk with others about overcoming living with a narcissist, see discussions in Mental Health https://connect.mayoclinic.org/group/mental-health/
~ Narcissists ~ https://connect.mayoclinic.org/discussion/on-the-subject-of-narcissists/

Healthy Living https://connect.mayoclinic.org/group/healthy-living/

Just Want to Talk https://connect.mayoclinic.org/group/other/ This group covers all sorts of discussions like
– Gratitude Discussion Group https://connect.mayoclinic.org/discussion/gratitude-discussion-group/
– How about a laugh, (hopefully) https://connect.mayoclinic.org/discussion/how-about-a-laugh-hopefully/
– Art for Healing https://connect.mayoclinic.org/discussion/art-for-healing/

and so much more. I hope you'll explore some of the options. Let me know if I can help you find anything on Connect.

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@bonniep

Please contact the H.A.B.I.T. program at Mayo. It will be a life saver for you and a partner.
We now have active follow-up support group meeting that are so valuable.

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Today at the Alzheimers Association SW chapter annual research conference I learned that MCI is a condition, and dementia in its different forms is a disease. Works for us! Since there is little research $$ for any condition ……big pharma has no interest!

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