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

Apr 2, 2019 | Dr. Anne Shandera-Ochsner, HABIT Midwest Director | @dranneshanderaochsner | Comments (45)

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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?

20 Reactions

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jehjeh | @jehjeh | Sep 29 5:35pm
In reply to @janeejane "Dorisena, This is exactly what I needed to see... your response. I moved to our second..." + (show)
@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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@dorisena a lot of this sounds familiar. My hubby is very suspicious and it has been impossible to get him a good diagnosis. Doctors don't see him at his worst. The verbal anger recently turned physical and he swung his walker at me 3 or 4 times. I was surprised he didn't fall. A few days later he was diagnosed with a uti and I think that may have been the culprit. I'm in Washington state and a social worker told us that my mom could call Adult Protective Services if we needed help putting him into memory care. Fortunately, he didn't fight uson this. I wonder if your state has a similar agency? Maybe your dr. can refer you to a social worker?

Praying you get to a safe place. One should not have to live in fear like this.

REPLY
Anne Shandera-Ochsner, Ph.D. HABIT Midwest Director | @anneshanderaochsner | Oct 7 10:19am
In reply to @bethyh79 "Is a five hour exam really necessary to make a diagnosis? My husband was diagnosed with..." + (show)
@bethyh79

Is a five hour exam really necessary to make a diagnosis? My husband was diagnosed with mild memory impairment two years aago. Did ok on the MOCA test. Had an MRI and showed normal brain size for a 85 year old man. His memory is getting worse and repeats questions constantly at times. He does cross words puzzles and plays scrabble. Neurologist suggested meds to slow down process but he was not interested.Should we go for another evaluation?

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@bethyh79 - thanks for your comment and question. The comprehensive neuropsychological assessment is the gold standard for evaluating thinking/memory problems. For someone your husband's age, many neuropsychologists will be mindful to keep the testing visit as short as possible, so it really may not be a 5 hour appointment. Most of my patients are in the clinic for more like 3 hours total (including time spent talking with me outside of testing). Many people find it extremely helpful to understand the specific areas of cognitive functioning that are impacted, and to what degree (mild, moderate, severe). The neuropsychologist can also give lots of non-medication recommendations to you and your husband, which sounds like something you may be interested in. Hope this is helpful for you!

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1 reply
bethyh79 | @bethyh79 | Oct 7 5:38pm
In reply to @anneshanderaochsner "@bethyh79 - thanks for your comment and question. The comprehensive neuropsychological assessment is the gold standard..." + (show)
@anneshanderaochsner

@bethyh79 - thanks for your comment and question. The comprehensive neuropsychological assessment is the gold standard for evaluating thinking/memory problems. For someone your husband's age, many neuropsychologists will be mindful to keep the testing visit as short as possible, so it really may not be a 5 hour appointment. Most of my patients are in the clinic for more like 3 hours total (including time spent talking with me outside of testing). Many people find it extremely helpful to understand the specific areas of cognitive functioning that are impacted, and to what degree (mild, moderate, severe). The neuropsychologist can also give lots of non-medication recommendations to you and your husband, which sounds like something you may be interested in. Hope this is helpful for you!

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Thank you so much for the information. You have given me lots to think about. A neuropsychologist is different than a neurologist so I would have to go to a different doctor.

Thanks again.

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SusanEllen66 | @SusanEllen66 | Oct 8 11:05pm

@anneshanderaochsner I had to wait almost 5 months to see a Neuropsychologist this year. I did the test and the discussion with the doctor. His opinion was that I have LB Dementia instead of Alzheimer’s. However my neurologist tossed off that diagnosis. They won’t share the report with me.
I am waiting for an appointment with a new neurologist.
I feel like a football. When a person is going through the process of diagnosis of suspected dementia they are stressed out. Having a doctor who respects, and honors your emotions is healing.

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gregd1956 | @gregd1956 | Oct 9 2:02pm

xxx YES AND A DIFFERENCE BETWEEN… xxx
Yes of: MCI < > dementia, but ravin of saying or hearing or misunderstanding for TBI people, like me. Yes, I’m weak in my brain. It’s it too easy getting a diagnosis of “dementia” for brain-injuries?

xxx 3 DIFFERENCES? xxx
1. MCI - Mild Cognitive Impairment
That’s me! But where’s that word “Mild”? What does that mean? Sure, no jail-time for me; no hitting people for me; no yelling… ok, there’s a few, little ones; no cussing - just a few; writing horrible, lousy, uggg writing, that’s me 🙂

Hey, who remember the early Microsoft Windows’, decades ago, when for 🙂 instead today’s picture of funny?

2. Dementia - I hate that word, but “marked by the development of multiple cognitive defective” . The Latin word was written as “demens from de-without men” - madness… oh boy… I’m there, but really small - tiny… I hope 🙂

3. TBI - Brain-Injury: accidents, playing football, falling down, being shot or hit, playing for boxing, and on. Yes, that makes me too easy of anything. My mom - who’s gone - had several sisters with dementia before. My mom had that but we saw that 15 year before stared: loss of memory, anger, upset by talking, and others. Do I selling my mom’s way from my 12 years ago accident?

Hey, that was that day of loss of memory, anger, upset, loss of words of talking, knowing, or hearing. I’ve been there, but my life went to the opposite than my mom. I thank God has given my human-life for now with my wife, families, and friends. Yes, I lost some of this: 80% of my knowledge & use of my brain; ability to drive back (what happens of no more driving of store, meds, traveling?).

Well thx guys,
Greg D. @greg1956

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