Is it normal aging or mild cognitive impairment?

⏱ 5 min read

Understanding the difference between normal aging and mild cognitive impairment (MCI) is crucial for recognizing when cognitive changes may require attention. In this webinar recording, Drs. Anthony Levinson and Richard Sztramko provide valuable insights into these distinctions, the risk factors, and strategies for managing cognitive health.

Download a transcript of this video.

"Mild cognitive impairment is probably best thought of as somewhere between normal aging and dementia", explains Dr. Levinson. This means that while there are noticeable cognitive changes, they are not severe enough to significantly disrupt daily life. These changes often relate to memory, but can also involve other cognitive functions.

Normal aging brings about some cognitive changes, such as slower thinking speed and challenges with complex tasks. However, these changes do not impact independence. "The brain is not different from other organs or experiences that you have. You might not be able to run as fast or jump as high, and the brain might not function exactly as it once did," notes Dr. Sztramko. He emphasizes that while there may be some decline in memory, other aspects like vocabulary and wisdom can improve over time.

When comparing normal aging to MCI, it is important to recognize the consistency and impact of cognitive lapses. Mild forgetfulness, such as occasionally not remembering something, is common in normal aging. In contrast, MCI involves a consistent pattern of memory lapses that are noticeable to the individual and their close contacts. "People with mild cognitive impairment will have more consistent challenges with planning, organizing, and problem-solving," says Dr. Sztramko. “These challenges are often first noticed in areas like finances or skills that require multitasking, like cooking complex meals.”

The distinction between MCI and dementia is also significant. "People living with dementia usually have significant memory loss that disrupts daily life and may include forgetting important events or people," explains Dr. Sztramko. In dementia, individuals may struggle with tasks to the point that it interferes with independence and the ability to carry out day-to-day functions, which is not the case with MCI.

Risk factors for MCI are similar to those for dementia and can be divided into modifiable and non-modifiable categories. Modifiable risk factors include physical inactivity, poor blood vessel health, hearing and vision loss, and cognitive and social inactivity. Dr. Levinson highlights, "High blood pressure, high cholesterol, and diabetes emerge as probably the most important vascular risk factors for mild cognitive impairment." Non-modifiable risk factors include age, gender, and family history.

Underlying diseases and conditions can also impact cognition. Conditions like Alzheimer disease, vascular disease, and Parkinson disease are common contributors to MCI. It is essential to rule out potentially reversible causes of cognitive impairment, such as medication side effects, metabolic diseases, and vitamin deficiencies. "Some of the vitamin deficiencies, such as vitamin B12 deficiency, may cause cognitive impairments like MCI, and may improve with treatment," notes Dr. Levinson.

For those experiencing symptoms of MCI, the first step is to contact a primary care provider. They can administer cognitive tests and refer patients to specialized memory clinics if needed. Treatment options depend on the underlying cause of MCI. Addressing conditions like depression, adjusting medications, and promoting brain health through diet, exercise, and social activity are all important strategies. "It always depends on the underlying cause of the MCI itself," says Dr. Sztramko.

Promoting brain health is crucial for reducing the risk of MCI and dementia. Physical activity, weight management, blood vessel health, a healthy diet, and avoiding smoking and excessive alcohol consumption are all beneficial. Cognitive and social activities are also important. "The things you do to help reduce your risk of cognitive impairment are also things that can reduce your risk of heart disease, stroke, and cancer," emphasizes Dr. Levinson. “What’s good for the brain, is good for the body; and vice versa.”

Addressing denial about cognitive decline can be challenging. It is important to be kind and consistent in feedback and to seek the help of a trusted professional. Documenting instances of cognitive lapses can provide objective evidence. "We do see with some people, emotional and behavioural changes related to the mild cognitive impairment," notes Dr. Levinson. These emotional and behavioural changes can make it more difficult for individuals to accept their condition, and not every person with MCI has insight into the changes.

Understanding the differences between normal aging and MCI, recognizing the risk factors, and taking proactive steps to promote brain health are essential for managing cognitive changes. Early evaluation and treatment can help maintain cognitive function and improve quality of life. There are also other evidence-based memory strategies that can help to accommodate for some of the changes with MCI. For example, many people benefit from using an agenda, notebook, or smartphone to help keep track of things or for reminders.  As Dr. Levinson advises, "Stay curious, stay active with your health, stay socially engaged, and that can also help you to maintain function as long as possible."

Key moments from the webinar recording include:

• 00:00 - What is mild cognitive impairment?
• 01:45 - Normal changes associated with aging
• 05:40 - Normal aging vs. mild cognitive impairment (MCI)
• 06:46 - Differences between MCI and dementia
• 07:32 - When to be concerned about cognitive changes
• 09:04 - Risk factors for mild cognitive impairment (MCI)
• 11:03 - Impact of underlying diseases on cognition
• 13:32 - Progression of mild cognitive impairment over time
• 15:15 - How to get evaluated for mild cognitive impairment (MCI)
• 16:09 - Treatment options for mild cognitive impairment (MCI)
• 18:54 - Promoting brain health
• 20:40 - Strategies to manage mild cognitive impairment
• 24:00 - Why cognitive function varies day to day
• 25:18 - Impact of COVID-19 and long COVID on cognition
• 28:09 - Importance of annual reassessment for MCI
• 33:50 - Advances and challenges in biomarker research
• 38:50 - Cognitive side effects of medications
• 43:51 - Vitamin B12 deficiency and cognitive impairment
• 48:01 - Addressing denial about cognitive decline
• 51:52 - Sleep disorders and cognitive impairment
• 56:11 - Long-term use of antidepressants and risk of MCI or dementia
• 57:48 - Concussions and increased risk for MCI or dementia

Learn more about mild cognitive impairment.

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