Mild Cognitive Impairment (MCI)

We're hearing more and more about Mild Cognitive Impairment (MCI) in discussion and education. What exactly is the difference between MCI and dementia? In a nutshell, a person is said to have MCI if they have some sort of impairment that is beyond normal age-related changes but that does not prevent them for carrying on with day to day life and normal activities. People with dementia, on the other hand, have symptoms that impact daily life. People with mild cognitive impairment may never develop Alzheimer's or other types of dementia but almost all cases of Alzheimer's start with MCI.

A person with MCI may find that they forget things more often than normal, they may lose interest in doing things that they previously enjoyed, they may have trouble finding their way around familiar places and they may have trouble with abstract thinking.

These changes often lead a person to withdraw and avoid many situations because they are no longer as comfortable as they once were. In the past, the person kept themselves occupied and motivated, but now, little by little they may stop doing things. Recognizing these changes is important, and we must find a way to overcome them.

So how we do we go about doing this?

Generally, a person with mild cognitive impairment stops doing something because there is some aspect to the activity that they find too challenging. The key is to determine what that obstacle is and modify the activity to remove it. For example, a person may always have had a jigsaw puzzle on the go, but you notice that they haven't moved a piece in weeks. Perhaps the person finds that the puzzle is too difficult because it has too many pieces, or maybe the image is a tough one. You could casually suggest that the puzzle on the table isn't very good, replace it with a more appropriate one and put together some of the pieces to get the person interested again.

Another example might be that you always had a nightly cribbage game, but now the person avoids it and doesn't want to play. It is likely that they find the scoring and strategy of cribbage too challenging and frustrating. Try suggesting that you'd rather play a different game and suggest something more appropriate, either cards or a different type of game altogether.

The key is to try to find a way to allow the person with MCI to get the enjoyment back and continue to do the things that they always enjoyed doing.

There may be some things that they no longer do that you don't even notice because they have stopped gradually over time. Maybe they used to go for a walk, then once winter set in they stopped and didn’t start again even with the nice weather. Maybe they used to spend time in their workshop, have a knitting group, go to the movies every week. Now they aren't doing any of those things.

These activities gave a balance to their life and contributed to their quality of life and their overall wellness. It is important to find ways to regain this balance. Because the person is no longer doing these things, they are no longer getting the benefit of the activity. We need to either encourage them to take it up again, or find replacement activities that provide the same benefit.

Some important areas include:

Exercise

We get exercise in many ways during our normal day, even without a specific exercise program. Taking the dog for his twice-daily walks, a physically demanding job, hobbies such as gardening all provide exercise. If these are no longer part of the daily routine, activities such as going to the mall to walk, going bowling, joining a senior's class such as tai chi or Elderfit swimming can all provide alternatives for the person with MCI.

Encouraging Creativity

Creativity involves using our imagination and thinking beyond normal rules and ideas. We often experience creativity through our jobs, playing in a band, singing in the church choir, our hobbies and more. Some activities that can replace these creative outlets include going to local art galleries and showings, taking lessons in something new that was always of interest (such as painting, pottery, photography, etc) or playing a musical instrument.

Mentally Stimulating Activities

Keeping the mind active is important for everyone, and even more so for someone with MCI. Our work, hobbies such as jigsaw puzzles and word puzzles, bridge groups, book clubs, even just planning our time all provide stimulation and cognitive challenges. It is important that this stimulation be maintained or replaced with different challenging and stimulating activities.

Social Connection

People are social beings and the social interactions provide important benefits. Research shows that these benefits include lower risk of some medical conditions, reduced risk of depression and lower risk of developing Alzheimer's disease or some other types of dementia. In the course of our daily life we usually have many instances of social interaction including work, community involvement, getting together with friends, participating in group activities and more. Even without being actively involved, the person with mild cognitive impairment can maintain social interactions through things such as attending church suppers, meeting friends for coffee, or participating in group activities.

Most activities provide several benefits. Joining a senior's exercise class, for example, provides both exercise and a social outlet. Taking up some sort of art hobby provides creativity and cognitive challenges and possibly even social benefits if done in a group (such as a painting class). The important thing is for the person to stay active, be involved in a variety of activities and not retreat from challenges.