Does Mild Cognitive Impairment Always Lead to Dementia?

David Koulack, journalist and retired psychology professor, feels shaky every morning when he wakes up. Lately, he has also become forgetful when it comes to things he used to do every day, such as getting on and off his bike. For him, the old saying, “(y)ou never forget how to ride a bike,” just didn’t ring true anymore.

Recently, David began forgetting names of his neighbors and important things he had to do on a given day. After a fall and a subsequent visit to a neurologist, David learned that he has mild cognitive impairment (MCI). He is documenting his journey in a Next Avenue series, and sharing the many ways he has been coping with forgetting things and doing whatever he can to stave off dementia.

For those who have MCI, there are slight changes to the brain that affect memory, decision-making, or reasoning skills. In many cases, MCI progresses to Alzheimer’s disease or other types of dementia, but not always.

Groundbreaking Study Conducted on those with MCI and Alzheimer’s

There have been many studies on the prevalence of Alzheimer’s, yet few have characterized the proportion of cases that are mild, moderate, or severe. Recently, a new study published in the Journal of Alzheimer’s Disease, describes how most people living with Alzheimer’s may have mild rather than moderate or severe cases.

To conduct the study, researchers looked at data from the Framingham Heart Study (FHS), a long-term research project that has followed the health of thousands of people for decades. Led by a team at Boston University, the scientists analyzed medical information for more than 17,000 people ages 50-94 with MCI or mild Alzheimer’s dementia.

Among people with Alzheimer’s disease, 50.4% had a mild form of the disease, 30.3% had moderate disease, and 19.3% had severe disease. This means that half of all cases in the study could be categorized as mild. Among participants with either Alzheimer’s or MCI, 29.5% had MCI that did not get worse over time and 19.6% had MCI that got worse over time and led to dementia.

How This Study Can Help Further Future Research

Understanding the prevalence of different disease severities is important for any condition, but especially for conditions such as Alzheimer’s, which progress over time. The study described and the findings that half of people with Alzheimer’s had a mild form shows how important it is to work on treatments toward slowing the progression of this disease. If, in the future, Alzheimer’s disease can be diagnosed and treated in its mildest form, it could mean a greater quality of life and better health for many people.

Scientists are recommending that this research be repeated in larger and more diverse groups of people. Better understanding of this topic could help scientists more effectively plan research and allocate future resources, particularly those targeted at various stages of disease, including MCI.

How Likely is MCI to Progress to Dementia?

The likelihood of progression from MCI to any form of dementia has been suggested to occur at a rate 3 to 5 times higher than those with normal cognition, with an annual rate of progression of 12% in the general population and up to 20% in populations at higher risk. Much attention has been focused on the identification of modifiable and nonmodifiable risk factors to prevent or delay the progression of MCI to dementia.

Risk factors for the development of dementias include age, genetic characteristics, lower educational attainment, and other clinical characteristics. Among those with MCI, several risk factors influencing the progression to dementia are discussed in detail in this clinical review.

Brain Activities to Cope with MCI or Mild or Early-Stage Alzheimer’s

Hopefully, after more studies similar to the one described, additional information will be available to help slow the progression of dementia. For now, there are things you can do.

As described earlier, in his articles, David writes about how he is coping with his MCI and how he is doing what he can to prevent dementia in his future. David is following his doctor’s recommendation of a daily dose of cod liver oil and consuming foods that are rich in Omega 3 fatty acids, such as avocados and fish.

Regular aerobic exercise also increases blood flow to the brain, which may help slow mental decline in older adults. This is why David’s doctor also suggested that David should try to do as much walking as possible, and David and his dog, Mabel, are certainly up to the task.

Besides regular exercise, David always tries to get a good night’s sleep. As the founder of the first sleep and dream research lab at the University of Manitoba, David has studied sleep, understands its importance, and know the practices to follow that help to ensure having a good night’s sleep. Lastly, he believes that the simple process of interaction with other human beings — walking and talking together, playing games with each other, and having meals together is very important and will become easier once more people are vaccinated.

Additional Activities to Help Keep Your Brain Sharp

Besides the activities suggested by David, there are other things you can do to keep your mind sharp. Harvard recently published a list of mentally stimulating activities for those with MCI or mild or early Alzheimer’s that require those with memory loss to have to do some work to process or produce information. These kinds of activities can include any of the following:

Learning a language: Bilingual people have greater mental flexibility and agility, and may have some protection from the risk of developing dementia, compared to people who speak only one language. Learning a second language later in life may even delay cognitive decline. To get started, listen to language recordings, take an online class, or download an app such as Babbel or Duolingo.
Listening to or making music: Music can activate almost all regions of the brain, including those involved with emotion, memory, and physical movement. Get in on this benefit by listening to new kinds of music, or by learning how to play an instrument. Check out playlists from other countries, or start learning to play an instrument by watching free videos on YouTube.
Playing card and board games: Games strengthen your ability to retrieve memories (if you play Trivial Pursuit, for example) or think strategically (if you play games like chess or checkers). Playing card games is helpful because it requires you to use a number of mental skills at once: memory, visualization, and sequencing.
Traveling: Visiting a new place exposes you to sights and sounds that enhance brain plasticity, forming new connections in your brain. You might not be able to travel far during the pandemic, but simply exploring areas nearby may produce brain changes.
Watching plays, films, concerts, or museum tours: Cultural activities stimulate the brain in many ways. While you may not be able to enjoy these activities indoors right now, it might be possible to see them outside or online. Choose something that requires a little effort to understand it, for example a Shakespearean play or a foreign film. If you’re watching a concert, choose one with complex classical compositions. If you’re looking at an online museum exhibit, try to pick up on the details the artist used to convey a message.
Word puzzles: Working on word puzzles (such as a crossword, Jumble, or Sudoku) has been shown to help people improve their scores on tests of attention, reasoning, and memory. Try a different kind of puzzle each day (for example, a Sudoku one day, a Jumble the next), and increase the level of difficulty as puzzles get easier.

Plan for the Future

Alzheimer’s and other forms of dementia are progressive and get worse over time.  For those with an Alzheimer’s or dementia diagnoses, there will likely come a time when you will need more care and support than you or a loved one can provide in your home. If you or a loved one suffer from Alzheimer’s or another form of dementia, you will face special legal and financial needs as your disease progresses. The best time to plan is now, while you can still contribute to important decisions about your future and your loved ones.

At the Farr Law Firm, we assist clients and family members of those with Alzheimer’s and other dementias through the process of Life Care Planning, which includes Medicaid Planning (also called Medicaid Asset Protection Planning) and planning for the Veterans aid and attendance benefit. Our goal is to help the client and their family navigate the Aging Continuum, which often includes protecting a client’s hard-earned assets while maintaining comfort, dignity, and quality of life and ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. If your family is facing a diagnosis of Alzheimer’s disease or any other type of dementia, please call us as soon as possible to make an appointment for an initial consultation:

Life Care Planning Fairfax, VA: 703-691-1888
Life Care Planning Fredericksburg, VA: 540-479-1435
Life Care Planning Rockville, MD: 301-519-8041
Life Care Planning Washington, DC: 202-587-2797

Print This Page
About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.