Cognitive

Mild Cognitive Impairment

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Mild Cognitive Impairment, Significant Forgetfulness

  • See Also
  1. Dementia
  2. Dementia Diagnosis
  • Epidemiology
  1. Prevalence in U.S.
    1. Age 65 to 74 years: 21.9%
    2. Age 75 to 84 years: 24.6%
    3. Age >=85 years: 22.1%
    4. Rajan (2021) Alzheimers Dement 17(12): 1966-75 [PubMed]
  • Findings
  1. See Dementia
  • Differential Diagnosis
  1. See Altered Level of Consciousness Causes
  2. See Dementia Causes
  3. See Toxin Induced Neurologic Changes
  4. See Beer's List (esp. Benzodiazepines, Anticholinergic Medications)
  5. Dementia
  6. Major Depression
  7. Chemical Dependency
  8. Vitamin B12 Deficiency
  • Evaluation
  1. See Dementia (includes screening and diagnostic tools)
  2. See Dementia Diagnosis (same evaluation tools are used)
  3. See Mental Status Exam
  4. Routine screening of asymptomatic older patients is not currently recommended by USPTF
    1. Moyer (2014) Ann Intern Med 160:291-7 [PubMed]
  • Diagnosis
  1. See Dementia Diagnosis
  2. Complaint of Memory Loss and impaired for age
    1. Significant Forgetfulness
  3. Does not meet criteria for Dementia
    1. Normal general cognitive functioning (or mild changes in at least one cognitive domain)
    2. Normal Activities of Daily Living (Cognitive Impairment does not significantly impact functioning)
  4. Other conditions are excluded
    1. See Dementia Differential Diagnosis
    2. Major Depression screening is negative (See Dementia Diagnosis)
  5. Consider Consultation (see Dementia for indications)
    1. Neuropsychiatric testing
    2. Neurology Consultation
  • Labs
  1. See Dementia
  • Imaging
  1. MRI may show Amygdala degeneration (in cases at higher risk of progression to Dementia)
  • Management
  1. Lifestyle interventions may be helpful
    1. Encourage mentally stimulating activities
    2. Unclear efficacy of mentally challenging puzzles (e.g. crossword puzzles, Soduko), but may be helpful
    3. Encourage social engagement
    4. Increase Physical Activity
    5. Address Cardiac Risk Factors
  2. Avoid medications
    1. Avoid using Cholinesterase Inhibitors or Nemenda for Mild Cognitive Impairment
      1. Associated with adverse effects without evidence of benefit
    2. No evidence for consistent benefit from any herbal supplement (e.g. Ginkgo, coconut oil)
    3. No consistent evidence for Multivitamin supplementation (although unlikely to be harmful)
      1. (2024) Presc Lett 31(3): 16 [PubMed]
  • Course
  1. Improves spontaneously in up to 26 to 50% of cases
  2. May ultimately progress with age to Alzheimer's Dementia
    1. Progresses in 5-10% of patients/year compared with 1-2% without Mild Cognitive Impairment
  • References
  1. Cooper (2013) Br J Psychiatry 203:255-64 [PubMed]
  2. Kramer (2025) Am Fam Physician 112(6): 657-67 [PubMed]
  3. Peterson (2011) N Engl J Med 364:2227-34 [PubMed]