MILD COGNITIVE IMPAIRMENT: SYMPTOMS, CAUSES AND TREATMENTS - ECONOMÍA - 2025

The mild cognitive impairment is a syndrome may have cognitive deficits beyond what is considered normal, which may or may not be interference with daily life and does not meet the criteria for dementia.

That is, mild cognitive impairment, as its name suggests, is a type of cognitive impairment that is characterized by being mild (the deficits are not very important), but they are notorious enough not to be explained by normal aging of the child. brain.

People, as we get older, we lose our mental faculties. We lose speed of thought, we are less and less agile mentally, our ability to learn decreases, it may cost us more to remember things…

However, this slight cognitive decline is not considered any type of disease, and is classified as "age-related cognitive impairment" (DECAE).

DECAE is considered a relatively benign phenomenon, and practically all of us present it (to a greater or lesser intensity) as we age. No one is free from losing faculties with age.

characteristics

Pathological

Mild cognitive impairment does not refer to benign aging of the human brain, but is considered a type of impairment greater than that seen in a DECAE.

Therefore, mild cognitive impairment would constitute those types of cognitive decline that are not purely associated with age and are therefore not considered "normal" but rather pathological.

It's not dementia

Normally when we talk about pathological cognitive impairment, we are usually talking about dementia, such as dementia type Alzheimer's or dementia due to Parkinson's disease.

However, mild cognitive impairment is not a dementia, it is a type of cognitive impairment less than that presented in any type of dementia syndrome.

Mild cognitive impairment refers to those people who are neither cognitively normal (they have a greater deterioration than should be expected due to age) nor insane (they have a lesser deterioration than people with Dementia).

It is not linked in all cases to dementia syndrome

However, it has been shown that not all people with mild cognitive impairment end up suffering from dementia syndrome.

More specifically, taking into account the data provided by Iñiguez in 2006, only between 10% and 15% of patients with mild cognitive impairment end up developing a dementia syndrome.

In summary, mild cognitive impairment is a type of impairment greater than that considered "normal" but less than that for dementia syndromes.

In addition, this disease increases the probability of ending up suffering from a dementia syndrome from 1-2% (for healthy people) to 10-15% (for people with mild cognitive impairment).

Subtypes

Although the deficits of mild cognitive impairment are mild, the presentation of this disorder can vary and the type of cognitive decline can be in several forms.

Thus, currently 4 subtypes of mild cognitive impairment have been described, each with specific characteristics. Let's quickly review them.

Single domain amnestic mild cognitive impairment

A patient whose only cognitive complaint is related to a deficit in memory would be labeled in this subtype. It is the most common subtype and is characterized in that the person does not present any type of cognitive deficit beyond a slight memory loss.

For certain authors, this subtype of mild cognitive impairment could be considered a pre-Alzheimer's disease stage.

Mild amnesic cognitive impairment with involvement in multiple areas

A patient with memory loss and complaints in other cognitive areas such as problem solving, word naming or attention and concentration difficulties would be framed in this subtype.

Multiple cognitive deficits may occur, but all of them are of low intensity, so it could not be considered a dementia syndrome.

Non-amnesic mild cognitive impairment with involvement in multiple areas

A patient without any type of alteration in his memory but with difficulties in other cognitive areas such as attention, concentration, language, calculation or problem solving would be diagnosed with non-amnesic mild cognitive impairment with affectations in multiple areas.

In this subtype, as in the previous one, multiple low intensity cognitive deficits can occur, but with the difference that there is no memory loss.

Non-amnesic single domain mild cognitive impairment

Finally, a patient who, as in the previous case, does not present memory loss and only presents one of the other cognitive deficits previously described, would be included within this subtype of mild cognitive impairment.

Symptoms and diagnosis

The diagnosis of mild cognitive impairment is often complex, or since there are no precise and universally established criteria to detect this disorder.

The main requirement for the diagnosis is to present evidence of cognitive impairment through neuropsychological examination (mental performance tests) without these meeting the criteria for dementia.

Despite the lack of stable diagnostic criteria to detect mild cognitive impairment, I will now comment on those proposed by the International Psychogeriatric Association, which in my opinion clarify several concepts:

Decrease in cognitive ability at any age.

Decrease in cognitive ability stated by the patient or informant.

Gradual decrease of minimum duration of six months.

Any of the following areas may be affected:

Memory and Learning.

Attention and Concentration.

Thought.

Language.

Visuospatial function.

Decrease in mental state assessment scores or neuropsychological tests.

This situation cannot be explained by the presence of a Dementia or another medical cause.

The criteria for establishing the diagnosis of mild cognitive impairment are to present complaints of decline in cognitive abilities, that these are detectable through mental performance tests and that they are less serious than those of Dementia.

That is why being able to differentiate mild cognitive impairment from dementia is especially important, let's see how we can do it.

Main differences with dementia

Dementia syndromes are characterized by memory impairment and other cognitive disturbances such as language, planning, problem solving, apraxia or agnosia.

The characteristics of mild cognitive impairment are practically the same as those of dementia, since in mild cognitive impairment both memory deficits and the other cognitive deficits that we have just discussed can be witnessed.

Thus, mild cognitive impairment cannot be differentiated from dementia by the type of alterations that the person presents, since they are the same in both pathologies, therefore, the differentiation can only be made through the severity of these.

In this way, the keys to differentiate mild cognitive impairment from dementia are the following:

• Unlike dementia, the deterioration that occurs in mild cognitive impairment does not usually modify the functionality of the person excessively, which can continue to perform activities autonomously and without difficulties (except tasks that require a very high cognitive performance).
• In dementias, the learning capacity is usually null or very limited, whereas in mild cognitive impairment, although it has decreased, a certain capacity to learn new information may remain.
• People with dementia are often unable or have great difficulty in performing tasks such as handling money, shopping, orienting themselves on the street, etc. In contrast, people with mild cognitive impairment tend to manage more or less well for these types of tasks.
• The most typical deficits of mild cognitive impairment are memory loss, naming problems, and decreased verbal fluency, so the unique presentation of these 3 deficits (of low severity) makes the diagnosis of mild cognitive impairment more likely than of dementia.
• All mild cognitive impairment deficits are much less severe. To quantify this, a useful screening instrument is the Mini-Mental State Examination (MMSE). A score between 24 and 27 in this test would support a diagnosis of mild cognitive impairment, a score of less than 24 the diagnosis of Dementia.

Markers of mild cognitive impairment

Since mild cognitive impairment increases the risk of developing Alzheimer's dementia, current research has focused on identifying markers for both mild cognitive impairment and Alzheimer's.

Although there are still no clear markers, there are several biological, behavioral, psychological and neuropsychological markers that make it possible to differentiate both pathologies and predict which patients with mild cognitive impairment may develop dementia.

Biological markers

One of the main biomarkers of Alzheimer's disease (AD) are peptides in cerebrospinal fluid. In the neurons of people with Alzheimer's, higher amounts of the proteins Beta-amyloid, T-Tau and P-Tau have been detected.

When patients with mild cognitive impairment present high levels of these proteins in their brain, it is more than likely that they will develop AD, on the other hand, if they present normal levels of these proteins, the evolution towards AD becomes very unlikely.

Behavioral and psychological markers

A study carried out by Baquero in 2006 estimates that 62% of patients with mild cognitive impairment present some psychological or behavioral symptoms. The most common are depression and irritability.

Likewise, authors such as Lyketsos, Apostolova and Cummings, defend that symptoms such as apathy, anxiety and agitation (typical of depressions) increase the probability of developing AD in patients with mild cognitive impairment.

Neuropsychological markers

According to Íñieguez, those patients with mild cognitive impairment who present a fairly significant impairment of language and implicit memory or a notable alteration of episodic and working memory are more likely to develop AD than patients with mild cognitive impairment with another pattern of deficits.

Thus, by way of conclusion, it seems that the boundaries between mild cognitive impairment and dementia are not clearly defined.

Mild cognitive impairment could be defined as a low-intensity cognitive decline that does not excessively reduce the person's day-to-day life, but in some cases it may represent a phase prior to a serious, progressive and chronic dementia disorder.

References

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