Mild Cognitive Impairment (MCI): The Starting Point of Alzheimers Disease

• Frequent forgetfulness such as missing appointments or recently done tasks, pausing mid-sentence, struggling to find words, slower decision-making, getting lost in familiar places, or unintentionally doing inappropriate things may be warning signs of Mild Cognitive Impairment (MCI).
• Individuals with Mild Cognitive Impairment have a significantly higher risk of developing dementia compared to the general population. Some studies indicate this risk may be 3 to 5 times greater, depending on other contributing factors.
• The Oligomerized Beta-Amyloid (OAβ) blood test evaluates the risk of Alzheimer's disease and dementia. It can detect abnormal amyloid protein accumulation before symptoms appear, allowing for timely care planning and slowing disease progression.

What is Mild Cognitive Impairment (MCI)?

Mild Cognitive Impairment (MCI)is a condition characterized by decline in memory and thinking skills greater than expected for age, but not severe enough to interfere significantly with daily life as seen in dementia or Alzheimer's. However, MCI can be a risk factor for future Alzheimer's disease.

Causes of Mild Cognitive Impairment (MCI)

MCI can result from various causes such as brain cell degeneration, which is common, thyroid disease, nutritional deficiencies essential for brain cells,diabetes,cardiovascular and cerebrovascular diseases, or side effects from certain medications.

Risk factors for Mild Cognitive Impairment (MCI)

Risk factors for MCI include

• advanced age,
• genetics, especially those with the Apolipoprotein E (APOE) allele e4, which is associated with increased risk of Alzheimer's disease,
• high blood pressure,
• diabetes,
• high blood lipid levels, particularly elevated low-density lipoprotein (LDL) cholesterol,
• obesity,
• depression,
• obstructive sleep apnea,
• untreated vision or hearing loss,
• brain injury,
• physical inactivity or lack of exercise,
• alcohol consumption,
• smoking,
• lack of socially stimulating activities or limited social interactions with family, friends, or community,
• and exposure to air pollution, among others.

Warning signs of Mild Cognitive Impairment (MCI)

• Individuals with Mild Cognitive Impairment (MCI) commonly exhibit key symptoms such as
• memory impairment like forgetting important events or appointments, recent activities, or being unable to recall details from reading or watching a movie until the end,
• language difficulties, such as interrupted speech, forgetting words, or using incorrect words in context,
• difficulty with thinking, analysis, or decision-making, including inability to follow instructions completely or making inappropriate decisions in some situations,
• deficits in spatial orientation and memory, such as getting lost on familiar routes,
• These changes may be mild enough for the person to maintain daily routines normally, but family members or close contacts often notice abnormalities more clearly over time.

MCI carries a risk of progressing to Alzheimer's disease and dementia.

People with mild cognitive impairment have a significantly higher risk of developing dementia than the general population, with some studies suggesting the risk is 3 to 5 times higher. This risk depends on other contributing factors combined with MCI, such as age, APOE e4 gene presence, diabetes, high blood pressure, stroke, high cholesterol, insufficient exercise, smoking, alcohol use, poor sleep, depression, or chronic stress.

Studies also show that those with amnestic MCI (aMCI), marked by prominent memory impairment, have a higher risk of developing Alzheimer's than those with non-amnestic MCI (naMCI).

Preventing Mild Cognitive Impairment

Currently, there is no guaranteed method to prevent MCI, but behavior modification can reduce risk, such as

• avoiding excessive alcohol consumption,
• avoiding exposure to dust, smoke, and air pollution,
• reducing brain injury risk by wearing helmets when riding motorcycles,
• not smoking,
• managing and controlling physical conditions like diabetes, hypertension, elevated LDL cholesterol, obesity, and depression,
• getting adequate rest,
• eating a balanced diet rich in vegetables and fruits while reducing high-fat foods,
• socializing and engaging in activities with family, friends, or peers,
• regular moderate to vigorous exercise appropriate to individual capacity; those with chronic illnesses should consult a doctor before starting an exercise program to ensure safety,
• promptly addressing vision or hearing problems,
• participating in brain-stimulating activities or games such as mental arithmetic, puzzles, strategy games, planning tasks, learning new skills, or activities.

What is Alzheimer's testing and how does it relate to dementia?

Oligomerized beta amyloid testingis a medical test that assesses the risk of Alzheimer's disease and dementia by measuring the level of amyloid beta protein aggregation in the blood. This protein, when accumulated and clustered, can attach to brain cells causing their degeneration, leading to dementia and Alzheimer's later. The aggregation process begins 20 to 30 years before dementia symptoms appear.

When amyloid protein accumulates extensively, brain function declines starting from the hippocampus, responsible for new memory formation, then spreading to other brain areas, causing problems in learning, language, thinking, and behavior.

Therefore, measuring Oligomeric Beta-Amyloid in blood plays a role in early Alzheimer's risk assessment, enabling care planning and treatment initiation before clinical symptoms, potentially slowing disease progression and preserving brain function longer.

What is ApoE testing?

ApoE (Apolipoprotein E) testing analyzes genes involved in fat transport and protein clearance in the body, including amyloid beta protein removal from neurons. The ApoE gene has three main types; the ApoE e4 allele is linked to higher dementia risk because it reduces amyloid beta clearance efficiency, leading to greater accumulation and faster brain cell degeneration. Testing is done via blood or cheek tissue samples.

Apolipoprotein E (ApoE) gene testing is not a direct diagnostic test butan assessment of future Alzheimer's disease risk.Test results can guide lifestyle and behavior changes to reduce disease risk, such as general health care, controlling chronic conditions, appropriate exercise, and ongoing monitoring with neurology specialists.

Who should be screened for Alzheimer's and brain health to prevent risk?

At-risk individuals should undergo brain health screening for early diagnosis and prevention, enabling appropriate treatment and delaying disease symptoms. Groups who may benefit from screening include

• older adults aged 65 and above,
• those with a family history of Alzheimer's or dementia in direct relatives,
• individuals with genetic abnormalities such as Down syndrome or neurological disorders.

Diagnosis of Mild Cognitive Impairment

Diagnosing Mild Cognitive Impairment (MCI) requires evaluation by a neurology specialist using cognitive screening tests such as the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE), combined with symptom and behavioral history, physical and neurological exams, and ruling out dementia or other brain disorders. In some cases, brain imaging like CT or MRI may be recommended to confirm diagnosis and differentiate similar conditions.

Treatment of Mild Cognitive Impairment

Treatment of MCI includes both medication and non-medication approaches.

• Non-medication treatment Behavioral adjustment is the most important treatment for MCI, including regular exercise, cognitive training, social engagement and activities, nutrition management, controlling physical risk factors, stress management, and avoiding medications that may cause symptoms.
• Medication treatment Currently, no medication has proven clear benefits for MCI treatment. However, the 2021 dementia clinical practice guidelines suggest considering medication in early dementia diagnosis, which might apply to high-risk MCI patients. These drugs have side effects, so neurologist consultation is essential to weigh benefits against risks before use.Always

Information provided by Dr. Ekaphot Nimkulrat, Department of Internal Medicine,Samitivej Hospital