Sunday, 31 May 2015

Mild Cognitive Impairment

Like many I have struggled to understand what Mild Cognitive Impairment is, and how it differs from a dementia.

The other day I found a document on the Northumberland, Tyne and Wear NHS, website, and found that this explained things a lot easier than anything else had in the past three months.

I suppose that like many other people I wondered if Mild Cognitive Impairment was just a cop out.

 But having read this, it explains many of my problems, apart from things like my graphic nightmares.

This makes me wonder just how many people living with dementia, will have their diagnosis reversed at some later stage. 

Mild Cognitive Impairment


The aim of this leaflet is to provide you with information about Mild Cognitive Impairment.

If you are not sure about anything please ask a member of staff

What is Mild Cognitive Impairment (MCI?) 

If you are told that you have Mild Cognitive Impairment (MCI), this means that your mental abilities (cognition) are not as good as they used to be.
This usually refers to problems affecting memory, but involve a change in problem solving, thinking, attention, concentration, language or visual ability.

MCI is more than just normal forgetting, and means a difficulty, that is greater than it would be expected for normal ageing.

MCI is not the same as Dementia 
  People with MCI can be at risk of developing dementia in the future, but many do not develop more problems and a small number can recover

What causes MCI?  
 There are many different reasons why people develop MCI
Often it can be difficult to identify the underlying cause. Your doctor may or may not be able to say what the underlying cause of your difficulties is

What difficulties can be expected? 
The difficulties that those with MCI experience can vary and depend on what part of your cognition is affected.
The cognitive assessment that you completed, will have helped highlight the strengths and weaknesses in your ability.

Difficulties seen in MCI can include:-

Misplacing items
Difficulty retaining information, such as recalling phone messages or shopping lists
Forgetting what you have done recently and events you have attended
Forgetting what you are planning to do in the future, such as remembering appointments and dates
Forgetting what you went into a room to collect or do
Recalling the names of people or things.
Difficulty concentrating on tasks
Losing track of what you wanted to say in a conversation

Word finding difficulties - finding the right word you want to say in a conversation
Difficulty in describing objects or situations
Being less fluent in conversations with others

Problem solving
Difficulty planning and problem solving in relation to carrying out tasks, such as cooking, household chores, DIY tasks.
Difficulty adapting to changes in routine
A change in judgement, personality or behaviour

Experiencing more difficulty navigating and recalling directions
Difficulty judging distances
Difficulty coordinating tasks such as dressing

Other symptoms
 Low mood
Increased feelings of irritability or having more difficulty coping with stress
Apathy - loss of enthusiasm for previously enjoyed activities
Feelings can include sadness, anger, worry, or frustration

What can I do to help memory/cognitive difficulties?  
There are many different coping strategies that can make life easier, if you have noticed a change in memory

Making changes to your environment 

You can adapt your environment to help with memory difficulties, so that you do not need to rely on your memory as much

Use a notebook, calender or diary, to help you remember things
Put a notebook by the telephone to note down and phone calls and messages
Write important dates and appointments on a calender
Decide on a special place to keep items such as keys, or glasses. Make sure you put them back in the same place after using them, so you always know where to find them
Put information on a notice board
Use a pill box or weekly dispenser for tablets. These can be requested free of charge via your Doctor

Setting up a routine  
Another way to make life easier is to set up a routine. This can reduce any memory problems as you get used to expect, e.g. taking night time medication straight after cleaning teeth, or doing the weekly shopping on a Tuesday

Using memory aids

Memory aids can be important. These can take over some tasks that your memory does, and also reduce the number of things that you have to remember, which helps your memory work better.
All memory aids work best if you can make them part of your routine

Using a diary - to record what you do on a daily basis and keep track of your appointments

Notebook - to write down information that you want to remember

Calender - displayed in a prominent place can be a good way to note future appointments and social events. It is important to check this each day.

Making lists of what to do to stop doing - e.g. shopping lists
Notice board or wipe dry board - this is useful for leaving messages for family members and writing reminders to yourself. You could also record important phone numbers that you need to remember.

Sticky backed notes - these can be left in places around the home to remind you to do things.
Alarm clocks - timers, mobile phones - can be used as a prompt for activities such as taking food out of the oven

A tape recorder or Dictaphone - this is useful to record anything you want to remember.
Getting a newspaper daily - this can be a good prompt for the date

Maintaining well being

It is important to reduce any stress, anxiety or low mood as much as possible.
These difficulties have a negative impact on memory and concentration and can worsen memory problems
Continue to lead an active life and maintain all interests and activities that you enjoy - try not to stop any interests
If you notice that you are becoming low in mood or anxious, talk to close friends about your feelings
It can also be helpful to tell family and friends, about what difficulties you are experiencing and how they can support you, such as providing prompts and help with memory.

Try not to become concerned or embarrassed if you forget something.
If you have difficulty finding the right word or piece of information, try not to worry about this or try too hard to remember
Once you stop trying it will come back to you
Try to do one task at a time, as tackling too many things at once can become confusing
Take your time - there is no need to hurry
Break up tasks into small steps, to make them more manageable

Will my difficulties get any better?

For a few people with MCI, difficulties can get better if identified problems are due to physical health problems, or anxiety/ stress or low mood, and there is a subsequent improvement in well being
But for the majority of people with MCI, it is likely that problems will not ever get better.
However, problems might not get any worse either.
Some people with MCI can later experience a progression of their problems which might subsequently lead to a diagnosis of dementia. Of those only 10-15% per year develop dementia.

Can memory medications be used in MCI?
A number of studies completed have shown that using memory drugs for the treatment of MCI do not improve memory and will not prevent difficulties from getting worse.
The side effects are more pronounced when used in MCI and include higher rates of nausea, diarrhoea and leg cramps.
Therefore the memory drugs are not used in MCI.

How can someone have the best chance of avoiding dementia in the future?
Research has suggested that life style can affect a person’s risk of developing dementia.
There are steps that can be taken to reduce risk:-

Take regular exercise such as walking or swimming
Maintain the range of interests and activities that you previously enjoyed, such as socialising, with friends
Keep the mind active - doing crossword puzzles or word searches - as long as these are activities that you enjoy
Look after your health - stop smoking, refrain from exceeding the recommended amounts of alcohol, and avoid eating too many fatty foods

What would be the signs that my problems are getting worse

In the future, should you feel that your memory/ cognitive difficulties are getting worse, please discuss this with your doctor, who may re-refer you to the service.
Possible signs of difficulties getting worse are:-
Cognitive problems getting significantly worse and occurring more often.
It can also be helpful to check whether the family or close friends have noticed any changes

 Noticing difficulties occurring in other areas of ability such as attention/concentration, problem solving, language or visual ability.

Noticing a change in your ability in everyday life, to do tasks such as cooking, shopping, household chores

It is also worth considering how you have generally been feeling lately as increased stress, low mood, or an experience of loss can result in a temporary worsening of memory

MCI and driving

If driving is not affected then the DVLA (Driving and Vehicle Licensing Authority) does not need to be notified.
However for some people with MCI, the cognitive difficulties being experienced can impact on the driving ability.
 This might come to light through specific difficulties being identified from cognitive assessments, such as visual problem solving difficulties, or concern being raised about the possible change in the driving ability.
In these instances the DVLA should be notified to allow enquiries to take place

You will be advised as to whether you need to notify the DVLA.
Notifying the DVLA does not mean that you will be automatically stopped from driving, instead enquiries will be made to reach a decision around driving ability

In some cases a driving assessment may be required

Does the NHS really understand Dementia
