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What’s the Difference Between Mild Cognitive Impairment (MCI) and Dementia?
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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?
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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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1 ReactionHi @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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2 Reactions@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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1 ReactionGreat 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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2 Reactions@dorisena - thank you for your comments and willingness to share your experiences with others in the group.
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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1 ReactionI 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
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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2 ReactionsTwo 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
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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