Mild Cognitive Impairment Symptoms

The forgetfulness of normal aging is minor. You misplace your car keys or lose your car in the parking garage. Perhaps you can't remember the name of a former co-worker when you meet unexpectedly at the grocery store. This is nothing to worry about.

But red flags should go up if you start forgetting things you typically remember, such as doctor's appointments or your weekly television show. This happens to everyone now and then, but if a pattern develops, it could be a symptom of mild cognitive impairment.

Commonly symptoms of mild cognitive impairment are:

• Deficient memory, also confirmed by another person
• Essentially normal judgment, perception and reasoning skills
• Largely normal activities of daily living
• Reduced performance on cognitive tests, compared with other people of similar age and educational background

People with mild cognitive impairment may also experience:

• Depression
• Irritability
• Anxiety
• Aggression
• Apathy

Causes

Mild cognitive impairment often causes the same types of brain changes seen in Alzheimer's disease or other forms of dementia. The difference is in the extent of these changes, which is limited in mild cognitive impairment. These changes may include:
 

• Plaques, which are abnormal clumps of a protein called beta-amyloid
• Tangles, which are abnormal clumps of a protein called tau
• Decreased blood flow activity in the temporal and parietal lobes
• Shrinkage of the hippocampus, an area of the brain important for memory
• Strokes
• Lewy bodies, which are abnormal clumps of a protein that's associated with Parkinson's disease

Tests and diagnosis

Mental status exam
A short form of this type of test can be done in less than 10 minutes in your doctor's office. You may be asked to:

• Name today's date and your location
• Copy a design, such as intersecting pentagons
• Follow a three-stage command
• Remember a list of three words
• Follow a written direction
• Count backwards by sevens

 
Neurological exam
As part of a physical exam, your doctor may check for signs of Parkinson's disease, strokes, tumors or other medical conditions that can impair memory as well as physical function. The exam may test:

• Reflexes
• Eye movements
• Balance
• Sense of touch

Neuropsychological testing An examiner gives you various tasks to perform, which are specifically designed to test different areas of your thinking. Your results are then compared with those of people from a similar age and education level. This can help distinguish normal from abnormal cognitive aging, and may help identify patterns in cognitive functions that provide clues to the underlying condition.

Lab tests

Simple blood tests can rule out physical problems that can affect memory, such as vitamin B-12 deficiency or an underactive thyroid gland.

Brain Images

Your doctor may order a SPECT or PET scan to look for areas of hypoperfusion (low blood flow in your brain) or an MRI or CT scan to check for evidence of stroke or bleeding, and to rule out the possibility of a tumor.

Symptoms of Dementia

Symptoms of dementia vary depending on the cause and the area of the brain that is affected. Memory loss is usually the earliest and most noticeable symptom. Other key symptoms of dementia include:
 

• Having difficulty recalling recent events.
• Not recognizing familiar people and places.
• Having trouble finding the right words to express thoughts or name objects.
• Having difficulty performing calculations.
• Having problems planning and carrying out tasks, such as balancing a checkbook, following a recipe, or writing a letter.
• Having trouble exercising judgment, such as knowing what to do in an emergency.
• Having difficulty controlling moods or behaviors. Depression is common, and agitation or aggression may occur.
• Not keeping up personal care such as grooming or bathing.
• Some types of dementia cause key symptoms:
• People who have dementia with Lewy bodies often have highly detailed visual hallucinations. They may fall frequently.
• The first symptoms of frontotemporal dementia may be personality changes or unusual behavior. People with this condition may not express any caring for others, or they may say rude things, expose themselves, or make sexually explicit comments.
• Symptoms of dementia that come on suddenly suggest vascular dementia or possibly delirium-short-term confusion caused by a new or worsening illness.

Dimensial Exams and Tests

Doctors diagnose the cause of dementia by asking questions about the person's medical history and doing a physical exam, a mental status exam, and lab and imaging tests.

Tests can help the doctor learn whether dementia is caused by a treatable condition. Even for those dementias that cannot be reversed, knowing the type of dementia a person has can help the doctor prescribe medicines or other treatments that may improve mood and behavior and help the family.

Medical history

During a medical history and physical exam, the doctor will ask the affected person and a close relative or partner about recent illnesses or other life events that could cause memory loss or other symptoms such as behavioral problems. The doctor may ask the person to bring in all medicines he or she takes. This can help the doctor determine whether the problem might be caused by the person being overmedicated or having a drug interaction.

Although a person may have more than one illness causing dementia, symptoms sometimes can distinguish one form from another. For example, early in the course of frontotemporal dementia people may display a lack of social awareness and develop obsessions with eating, neither of which occurs early in other dementias.

Mental status exam

A doctor or other health professional will conduct a mental status exam. This test usually involves such activities as having the person tell what day and year it is, repeat a series of words, draw a clock face, and count back from 100 by 7s.  The problem with the mental status exam is that it is not very specific and will often miss subtle and early stages of dementia.

Lab tests

Numerous medical conditions can cause mental impairment. During a physical exam, the doctor will look for signs of other medical conditions and have lab tests done to find any treatable condition. Routine tests include:

•    Thyroid hormone tests to check for an underactive thyroid.
•    Vitamin B12 blood test to look for a vitamin deficiency.
•    Complete blood count, or CBC, to look for infections.
•    ALT or AST, blood tests that check liver function.
•    Syphilis test to look for this disease.
•    Chemistry screen to check the level of electrolytes in the blood and to check kidney function.
•    Glucose test to check the level of sugar in the blood.
•    HIV testing to look for AIDS.
•    Erythrocyte sedimentation rate, a blood test that looks for signs of inflammation in the body.
•    Toxicology screen, which examines blood, urine, or hair to look for drugs that could be causing problems.
•    Antinuclear antibodies, a blood test used to diagnose autoimmune diseases.
•    Testing for heavy metals in the blood, such as a lead test.

Imaging tests

Many experts recommend that people being assessed for dementia have a brain imaging test such as MRI or CT scan. These tests may rule out brain tumors, strokes, normal-pressure hydrocephalus, or other conditions that could cause dementia symptoms.

SPECT and PET scans-are also used to diagnose dementia.  They show the brain’s functioning rather than its anatomy (as Ct’s and MRI’s do).  They are often more sensitive tests and will note changes in the brain earlier—as the brain’s functioning is often affected before its anatomy changes.  These tests are also very helpful in distinguishing the different types of dementia, such as Alzheimer’s, vascular dementia, frontotemporal lobe, and normal pressure hydrocephalus.  These tests are particularly useful if the symptoms are confusing or odd.

In some cases, electrical activity in the brain may be measured using an electroencephalogram (EEG). Doctors seldom use this test to diagnose dementia, but they may use it to distinguish dementia from delirium and to look for unusual brain activity found in Creutzfeldt-Jakob disease, a rare cause of dementia.

In very rare cases, a brain biopsy may be done if a treatable cause of dementia is suspected.

After death, an autopsy may be done to find out for sure what caused dementia. This information may be helpful to family members concerned about genetic causes.