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Mild Cognitive Impairment vs Dementia: What's the difference?

Uncategorized Apr 28, 2019

Welcome back Careblazer. Thank you for being here. Today I want to talk about a question I’ve been seeing in the YT comments lately and it’s what is the difference between mild cognitive impairment (aka MCI) and dementia.

This is a bit technical on the exact definitions and what the healthcare community uses to diagnose but I’m going to try to explain it as simply and clearly as possible.

When we think about cognition, think about it on a continuum. We have “normal” thinking on one end and dementia on the other.

As a quick recap- there are many types of dementia. So on this end of the spectrum I’m talking about ALL the dementias- alzheimer’s, vascular, frontotemporal, lewy body, etc.

Here in the middle is what we call mild cognitive impairment. The official term is actually called mild neurocognitive disorder. Let’s go straight the source for the definition of both. Now when we talk about cognitive functioning, there are different domains- called neurocognitive domains. So if people are trying to find out if you are having any thinking problems, there needs to be a way to define what types of thinking problems there are. Most people only think about memory problems when they think about dementia but there are other thinking problems and did you know you actually don’t even need to have memory impairment to have dementia? That’s a little fact many people don’t realize.

So, according to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorder (aka DSM-5) there are 6 main neurocognitive domains. I’ll run through them quickly because they are important to know as we talk about mci and dementia but I’m not going to get too detailed into all the exact definitions of them. I think that’s worth a entirely separate video.

Complex attention: keeping attention over time, keeping attention despite distractions, being able to focus on 2 different tasks at once.

Executive function: Planning, decision making, working memory, feedback to solve a problem, override habits and inhibition, mental/cognitive flexibility
Learning and memory: Ability to repeat a list of words or digits or being able to learn new information and remember that information later.

Language: speaking and understanding language

Perceptual-motor: hand eye coordination, follow nonverbal behaviors, recognizing faces, seeing everything in the environment correctly.

Social cognition: behavior within social norms.

Now the difference between mild cognitive impairment and dementia or if I’m going to use the official correct terms that aren’t as well known in general community I’m talking about the difference between mild neurocognitive disorder and major neurocognitive disorder is the severity of the difficulty in any of those 6 cognitive domains.

So for example if we look at the learning/memory category a mild cognitive impairment may be having more difficulty recalling recent events, needing to rely more and more on lists and calendars to remember basic things, occasional repeating of yourself, losing track of when bills are paid.

But in dementia, it would be repeating themselves within the same conversation, not being able to keep track of a short list of items when shopping, needing reminders to remember what they are doing during a task. So in full blown dementia things are more severe.

Okay. Now let’s dive into the actual criteria for the disorders. They are VERY similar with the exception of the severity and you might be surprised at just how nonspecific the difference is between the two. And it’s clear we have SO much more we need to learn about these diseases.

MCI/MILD NEUROCOGNITIVE DISORDER

  1. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains based on:
    1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; AND
    2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
  2. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e. paying bills, managing medications, etc.). They may need to put forth more effort to do these tasks but they can still do them.
  3. The cognitive deficits to not occur exclusively during a delirium.
  4. The cognitive deficits are not better explained by another mental disorder (such as depression or schizophrenia).

 

In MAJOR NEUROCOGNITIVE DISORDER/DEMENTIA

  1. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains based on:
    1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; AND
    2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
  2. The cognitive deficits DO interfere with independence in everyday activities (such as paying bills and managing medications).
  3. The cognitive deficits to not occur exclusively during a delirium.
  4. The cognitive deficits are not better explained by another mental disorder (such as depression or schizophrenia).

Specify what the cognitive deficits are due to:

Alzheimer’s disease

Frontotemporal lobar degeneration

Lewy body dementia

Vascular disease

Traumatic brain injury

Substance/medication use

HIV infection

Prion disease

Parkinson’s disease

Huntington’s disease

Another medical condition

Multiple etiologies

Unspecified

 

Now some of you may be thinking, well that’s completely vague and subjective. How do you really tell the difference between a significant decline and a modest decline. Well, during neuropsychological testing, the test results of your loved one are compared to those of other people their same age and education whenever possible. The evaluator is looking to see where your loved one performed compared to other people similar to them and they look for how many standard deviations below the mean they performed. Now I think that may be getting a bit too technical and most of you may not care but what this does show is that there is still a LOT of room for improvement in identifying cognitive impairment at earlier stages as there is research showing that the earlier you catch the decline, the more hope there is for you to be able to stop and even reverse that decline.

 

Now, I hope this was somewhat helpful to you and didn’t confuse you anymore. What other questions do you have about cognitive decline or the difference between MCI and Dementia? Go ahead and leave it in a comment below.

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